Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India.
Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India.
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DOI：
10.1371/journal.pone.0193194
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Sarin S
中科院分区：
文献类型：
--
作者：
Raizada N;Khaparde SD;Salhotra VS;Rao R;Kalra A;Swaminathan S;Khanna A;Chopra KK;Hanif M;Singh V;Umadevi KR;Nair SA;Huddart S;Prakash CHS;Mall S;Singh P;Saha BK;Denkinger CM;Boehme C;Sarin S
儿童结核病的诊断具有挑战性，主要基于结核病病例的阳性接触史、临床和放射学发现，通常没有微生物证实。标本采集方面的挑战以及可在快速周转时间内应用的高灵敏度快速诊断检测的有限可用性也破坏了诊断工作。目前的项目是在印度的四个主要城市开展的，旨在通过为儿科疑似结核病例提供免费的Xpert检测来应对儿科人群的结核病诊断挑战，从而为更好的结核病治疗铺平道路。在四个项目城市中的每一个都建立了高通量实验室，并通过快速样本运输和电子报告链接与全市的各种医疗保健提供者联系起来。向所有在公共和私人卫生机构寻求治疗的儿科（0-14岁）推定结核病病例（肺结核和肺外结核）提供免费Xpert检测。当前项目从2014年4月至2016年6月招募了42，238例儿科推定结核病例。共检测到3 340例（7.91%，CI 7.65-8.17）细菌学确诊的结核病例，其中295例（8.83%，CI 7.9-9.86）为利福平耐药。项目队列中利福平耐药水平较高。总的来说，Xpert产生了高比例的有效结果，结核病检出率比涂片镜检高出三倍以上。该项目提供了当天检测和早期结果，导致快速治疗启动和成功率以及非常低的治疗失败率和失访率。目前的项目证明了通过每个城市的单个Xpert实验室以有效的方式对儿科推定结核病例进行快速和前期Xpert检测的可行性。快速的周转测试时间有助于及时和适当的治疗开始。这些结果表明，前期Xpert检测试剂盒是解决儿童结核病诊断的一种有前途的解决方案。从公共卫生角度来看，在该项目下检测的假定儿科结核病患者中检测到的高水平利福平耐药性是一个主要的关注点，这强调了需要进一步优先考虑将Xpert提前提供给这一弱势人群。
Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care. A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all pediatric (0–14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities. The current project enrolled 42,238 pediatric presumptive TB cases from April, 2014 to June, 2016. A total of 3,340 (7.91%, CI 7.65–8.17) bacteriologically confirmed TB cases were detected, of which 295 (8.83%, CI 7.9–9.86) were rifampicin-resistant. The level of rifampicin resistance in the project cohort was high. Overall Xpert yielded a high proportion of valid results and TB detection rates were more than three-fold higher than smear microscopy. The project provided same-day testing and early availability of results led to rapid treatment initiation and success rates and very low rates of treatment failure and loss to follow-up. The current project demonstrated the feasibility of rolling out rapid and upfront Xpert testing for pediatric presumptive TB cases through a single Xpert lab per city in an efficient manner. Rapid turnaround testing time facilitated prompt and appropriate treatment initiation. These results suggest that the upfront Xpert assay is a promising solution to address TB diagnosis in children. The high levels of rifampicin resistance detected in presumptive pediatric TB patients tested under the project are a major cause of concern from a public health perspective which underscores the need to further prioritize upfront Xpert access to this vulnerable population.
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DOI：
10.4103/0976-9668.159988
发表时间：
2015-07
期刊：
Journal of natural science, biology, and medicine
影响因子：
--
作者：
Kumar MK;Kumar P;Singh A
通讯作者：
Singh A
影响因子：
2.4
作者：
Dangisso MH;Datiko DG;Lindtjørn B
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影响因子：
56.3
作者：
Newton, Sandra M.;Brent, Andrew J.;Anderson, Suzanne;Whittaker, Elizabeth;Kampmann, Beate
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Kampmann, Beate
DOI：
10.5588/ijtld.16.0563
发表时间：
2017-06-01
影响因子：
4
作者：
Kalra, A.
通讯作者：
Kalra, A.
影响因子：
3.7
作者：
Chow F;Espiritu N;Gilman RH;Gutierrez R;Lopez S;Escombe AR;Evans CA;Moore DA
通讯作者：
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