title: Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert(®) MTB/RIF in Zimbabwe.
abstract: METHODS
  In Zimbabwe, there are concerns about the management of tuberculosis (TB) patients with rifampicin (RMP) resistance diagnosed using Xpert(®) MTB/RIF.
  
  
  OBJECTIVE
  To assess linkages between diagnosis and treatment for these patients in Harare and Manicaland provinces in 2014.
  
  
  METHODS
  A retrospective cohort study.
  
  
  RESULTS
  Of 20 329 Xpert assays conducted, 90% were successful, 11% detected Mycobacterium tuberculosis and 4.5% showed RMP resistance. Of 77 patients with RMP-resistant TB diagnosed by Xpert, 70% had samples sent to the reference laboratory for culture and drug susceptibility testing (CDST); 53% of the samples arrived. In 21% the samples showed M. tuberculosis growth, and in 17% the DST results were recorded, all of which confirmed RMP resistance. Of the 77 patients, 34 (44%) never started treatment for multidrug-resistant (MDR) TB, with documented reasons being death, loss to follow-up and incorrect treatment. Of the 43 patients who started MDR-TB treatment, 12 (71%) in Harare and 17 (65%) in Manicaland started within 2 weeks of diagnosis.
  
  
  CONCLUSIONS
  Xpert has been rolled out successfully in two Zimbabwe provinces. However, the process of confirming CDST for Xpert-diagnosed RMP-resistant TB works poorly, and many patients are either delayed or never initiate MDR-TB treatment. These shortfalls must be addressed at the programmatic level.
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.
authors.forename: K
authors.initials: K
authors.lastname: Charambira
authors.affiliation: The Union, Paris, France ; National Tuberculosis Programme, Cotonou, Benin.
authors.forename: S
authors.initials: S
authors.lastname: Ade
authors.affiliation: The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.
authors.forename: R T
authors.initials: RT
authors.lastname: Ncube
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe.
authors.forename: C
authors.initials: C
authors.lastname: Zishiri
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: C
authors.initials: C
authors.lastname: Sandy
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: H
authors.initials: H
authors.lastname: Mutunzi
authors.affiliation: The Union, Paris, France ; Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: K
authors.initials: K
authors.lastname: Takarinda
authors.affiliation: The Union, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Owiti
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: P
authors.initials: P
authors.lastname: Mafaune
authors.affiliation: Harare City Health Department, Harare, Zimbabwe.
authors.forename: P
authors.initials: P
authors.lastname: Chonzi
keywords: MDR-TB; RMP resistance; SORT IT; Xpert MTB/RIF; culture and drug susceptibility testing; tuberculosis