Fig 1.
Time to diagnosis and treatment of presumptive rifampicin-resistant TB using Xpert.
Time between microscopic TB diagnosis and patient presentation for Xpert examination (a), Xpert result (b), time between Xpert result and patients visit for pre-treatment assessment (c), initiation of second line treatment (d), total time between microscopic TB diagnosis and diagnosis of RR-TB (e), and total time between RR-TB diagnosis and start of second line treatment (f). Total time between microscopic TB diagnosis and start of MDR-TB treatment (g).
Fig 2.
Flow chart of study participants.
MDR-TB: Multidrug-resistant TB, PMDT: Programmatic Management of Drug-resistant TB, NTM: Non-tuberculous Mycobacteria, DST: phenotypic Drug Susceptibility Testing. *pre-XDR (n = 27) and XDR (n = 3). ** Appropriate treatment was defined as compatibility between DST result and the choice of drug-resistant treatment regimen. ***Patients with DST result not suggesting MDR continued their 2nd line treatment according to Indonesian PMDT guideline. aThe 200 patients were not tested due to possible reasons, which were: 1) patients didn’t present to the laboratory for Xpert testing; 2) patients weren’t able to expectorate sputum.
Fig 3.
Cascade of care and time to diagnosis and treatment of Xpert rifampicin-resistant TB patients.
Values in the bars indicate number (percentages). *12 of 118 with a failed result were imputed as Xpert positive and assigned the censored time of 180 days. **Pre-treatment examination included blood & urine test, HIV test, chest X-ray, audiometry and psychiatric assessment. ***Data were only available for 201 patients. Median (IQR) times between: microscopic TB diagnosis and patient presentation for Xpert examination (a), Xpert examination and Xpert result (b), Xpert result and visit for pre-treatment assessment (c), pre-treatment assessment and initiation of second line treatment (d), microscopic TB diagnosis and diagnosis of RR-TB (e), Xpert result and initiation of second line treatment (f), microscopic TB diagnosis and initiation of second-line treatment (g).
Table 1.
Characteristics of Xpert rifampicin-resistant TB patients (n = 339).
Fig 4.
Kaplan Meier curves for time between specific cascade of care steps.
These figures show Kaplan-Meier time-to-event graphs for specific cascade of care steps between registration and Xpert result (n = 351) (A), Xpert result and pre-treatment examination (n = 339) (B), and pre-treatment examination and MDR-TB treatment initiation (n = 291) (C).
Table 2.
Multivariable analysis of factors associated with diagnostic and treatment delay of rifampicin-resistant TB patients.
Table 3.
Sputum culture and phenotypic drug resistance of 243 Xpert rifampicin-resistant TB patients.