J Korean Med Sci.  2020 Sep;35(35):e284. 10.3346/jkms.2020.35.e284.

Impact of Molecular Drug Susceptibility Testing on the Time to Multidrug-resistant Tuberculosis Treatment Initiation

• Jeon D
• Kang H
• Kwon YS
• Yim JJ
• Shim TS

• KMID: 2506083
• DOI: http://doi.org/10.3346/jkms.2020.35.e284

Abstract

Background
The purpose of this study was to evaluate the current status and trends in the coverage of molecular drug susceptibility testing (mDST), and the impact of mDST on the time to multidrug-resistant tuberculosis (MDR-TB) treatment initiation in Korea.
Methods
We included confirmed rifampin-resistant (RR)/MDR-TB patients who submitted application forms for novel drug uses to the National TB Expert Review Committee from September 1, 2016 to November 30, 2019. We retrospectively reviewed their medical records.
Results
Of the 621 MDR/RR-TB patients, mDST was performed in 442 (71.2%); Xpert MTB/ RIF (Xpert) alone in 109 (17.6%), MTBDRplus line probe assay (LPA) alone in 199 (32.0%), and both Xpert and LPA in 134 (21.6%) patients. The coverage rate of mDST has gradually increased to 70% in 2015, 50.7% in 2016, 67.9% in 2017, 75.2% in 2018, and 79.4% in 2019 (p for trend < 0.001). Median time to MDR-TB treatment initiation was 35 days (interquartile range 25–75 0–72), which has gradually decreased during the study period (p< 0.001).Independent predictors of shorter time to MDR-TB treatment initiation were retreatment case (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.10–1.54), Xpert testing (aHR, 2.42; 95% CI, 2.03–2.88), and LPA testing (aHR, 1.83; 95% CI, 1.55–2.16).Transfer to another healthcare facility was inversely related to shorter time to treatment initiation (aHR, 0.74; 95% CI, 0.63–0.88).
Conclusion
mDST coverage is gradually increasing and contributes to reducing the time to MDR-TB treatment initiation. Further efforts are needed to achieve universal access to mDST and to properly integrate mDST into routine clinical practice.

Keyword

Tuberculosis; Drug Resistance; Multidrug-Resistant Tuberculosis; Time to Treatment; Korea

Figure

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  Fig. 1 Annual trends in coverage of mDST (P < 0.001, P for trend < 0.001).mDST = molecular drug susceptibility testing.

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  Fig. 2 Distribution of time to multidrug-resistant tuberculosis treatment initiation.

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