title: Decreased Time to Treatment Initiation for Multidrug-Resistant Tuberculosis Patients after Use of Xpert MTB/RIF Test, Latvia.
abstract: Few studies have examined whether the Xpert MTB/RIF test improves time to treatment initiation for persons with multidrug-resistant tuberculosis (MDR TB). We determined the impact of this test in Latvia, where it was introduced in 2010. After descriptive analyses of pulmonary MDR TB patients in Latvia during 2009-2012, time to treatment initiation was calculated, and univariate and multivariable accelerated failure time models were constructed. Univariate results showed strong evidence of an association between having rifampin-resistant TB detected by Xpert MTB/RIF and reduced time to treatment initiation versus the test not being used. A multivariable model stratifying by previous TB showed similar results. Our finding that in Latvia, time to treatment initiation was decreased for MDR TB cases that were rifampin-resistant TB by XpertMTB/RIF has implications for the use of this test in other settings with a high burden of MDR TB in which rifampin resistance is highly predictive of MDR TB.
authors.forename: Helen R
authors.initials: HR
authors.lastname: Stagg
authors.forename: Peter J
authors.initials: PJ
authors.lastname: White
authors.forename: Vija
authors.initials: V
authors.lastname: Riekstiņa
authors.forename: Andra
authors.initials: A
authors.lastname: Cīrule
authors.forename: Ģirts
authors.initials: Ģ
authors.lastname: Šķenders
authors.forename: Vaira
authors.initials: V
authors.lastname: Leimane
authors.forename: Liga
authors.initials: L
authors.lastname: Kuksa
authors.forename: Gunta
authors.initials: G
authors.lastname: Dravniece
authors.forename: James
authors.initials: J
authors.lastname: Brown
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jackson
mesh_terms: D000293:Adolescent; D000328:Adult; D000904:Antibiotics, Antitubercular / Q000494:pharmacology; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007844:Latvia; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D012293:Rifampin / Q000494:pharmacology; D061665:Time-to-Treatment; D014374:Tuberculin Test / Q000379:methods*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin
keywords: Latvia; MDR TB; Xpert MTB/RIF; antimicrobial resistance; bacteria; molecular diagnostics; multidrug resistance; multidrug-resistant tuberculosis; pulmonary; rifampin; time to treatment initiation; tuberculosis and other mycobacteria