The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.

<h4>Background</h4>India has announced a goal of universal access to quality tuberculosis (TB) diagnosis and treatment. A number of novel diagnostics could help meet this important goal. The rollout of one such diagnostic, Xpert MTB/RIF (Xpert) is being considered, but if Xpert is used m...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Henrik Salje, Jason R Andrews, Sarang Deo, Srinath Satyanarayana, Amanda Y Sun, Madhukar Pai, David W Dowdy
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/cdff5f30b075414c8862715c13f8a2a8
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:cdff5f30b075414c8862715c13f8a2a8
record_format	dspace
spelling	oai:doaj.org-article:cdff5f30b075414c8862715c13f8a2a82021-11-25T05:36:42ZThe importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.1549-12771549-167610.1371/journal.pmed.1001674https://doaj.org/article/cdff5f30b075414c8862715c13f8a2a82014-07-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25025235/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>India has announced a goal of universal access to quality tuberculosis (TB) diagnosis and treatment. A number of novel diagnostics could help meet this important goal. The rollout of one such diagnostic, Xpert MTB/RIF (Xpert) is being considered, but if Xpert is used mainly for people with HIV or high risk of multidrug-resistant TB (MDR-TB) in the public sector, population-level impact may be limited.<h4>Methods and findings</h4>We developed a model of TB transmission, care-seeking behavior, and diagnostic/treatment practices in India and explored the impact of six different rollout strategies. Providing Xpert to 40% of public-sector patients with HIV or prior TB treatment (similar to current national strategy) reduced TB incidence by 0.2% (95% uncertainty range [UR]: -1.4%, 1.7%) and MDR-TB incidence by 2.4% (95% UR: -5.2%, 9.1%) relative to existing practice but required 2,500 additional MDR-TB treatments and 60 four-module GeneXpert systems at maximum capacity. Further including 20% of unselected symptomatic individuals in the public sector required 700 systems and reduced incidence by 2.1% (95% UR: 0.5%, 3.9%); a similar approach involving qualified private providers (providers who have received at least some training in allopathic or non-allopathic medicine) reduced incidence by 6.0% (95% UR: 3.9%, 7.9%) with similar resource outlay, but only if high treatment success was assured. Engaging 20% of all private-sector providers (qualified and informal [providers with no formal medical training]) had the greatest impact (14.1% reduction, 95% UR: 10.6%, 16.9%), but required >2,200 systems and reliable treatment referral. Improving referrals from informal providers for smear-based diagnosis in the public sector (without Xpert rollout) had substantially greater impact (6.3% reduction) than Xpert scale-up within the public sector. These findings are subject to substantial uncertainty regarding private-sector treatment patterns, patient care-seeking behavior, symptoms, and infectiousness over time; these uncertainties should be addressed by future research.<h4>Conclusions</h4>The impact of new diagnostics for TB control in India depends on implementation within the complex, fragmented health-care system. Transformative strategies will require private/informal-sector engagement, adequate referral systems, improved treatment quality, and substantial resources. Please see later in the article for the Editors' Summary.Henrik SaljeJason R AndrewsSarang DeoSrinath SatyanarayanaAmanda Y SunMadhukar PaiDavid W DowdyPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 11, Iss 7, p e1001674 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Henrik Salje Jason R Andrews Sarang Deo Srinath Satyanarayana Amanda Y Sun Madhukar Pai David W Dowdy The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.
description	<h4>Background</h4>India has announced a goal of universal access to quality tuberculosis (TB) diagnosis and treatment. A number of novel diagnostics could help meet this important goal. The rollout of one such diagnostic, Xpert MTB/RIF (Xpert) is being considered, but if Xpert is used mainly for people with HIV or high risk of multidrug-resistant TB (MDR-TB) in the public sector, population-level impact may be limited.<h4>Methods and findings</h4>We developed a model of TB transmission, care-seeking behavior, and diagnostic/treatment practices in India and explored the impact of six different rollout strategies. Providing Xpert to 40% of public-sector patients with HIV or prior TB treatment (similar to current national strategy) reduced TB incidence by 0.2% (95% uncertainty range [UR]: -1.4%, 1.7%) and MDR-TB incidence by 2.4% (95% UR: -5.2%, 9.1%) relative to existing practice but required 2,500 additional MDR-TB treatments and 60 four-module GeneXpert systems at maximum capacity. Further including 20% of unselected symptomatic individuals in the public sector required 700 systems and reduced incidence by 2.1% (95% UR: 0.5%, 3.9%); a similar approach involving qualified private providers (providers who have received at least some training in allopathic or non-allopathic medicine) reduced incidence by 6.0% (95% UR: 3.9%, 7.9%) with similar resource outlay, but only if high treatment success was assured. Engaging 20% of all private-sector providers (qualified and informal [providers with no formal medical training]) had the greatest impact (14.1% reduction, 95% UR: 10.6%, 16.9%), but required >2,200 systems and reliable treatment referral. Improving referrals from informal providers for smear-based diagnosis in the public sector (without Xpert rollout) had substantially greater impact (6.3% reduction) than Xpert scale-up within the public sector. These findings are subject to substantial uncertainty regarding private-sector treatment patterns, patient care-seeking behavior, symptoms, and infectiousness over time; these uncertainties should be addressed by future research.<h4>Conclusions</h4>The impact of new diagnostics for TB control in India depends on implementation within the complex, fragmented health-care system. Transformative strategies will require private/informal-sector engagement, adequate referral systems, improved treatment quality, and substantial resources. Please see later in the article for the Editors' Summary.
format	article
author	Henrik Salje Jason R Andrews Sarang Deo Srinath Satyanarayana Amanda Y Sun Madhukar Pai David W Dowdy
author_facet	Henrik Salje Jason R Andrews Sarang Deo Srinath Satyanarayana Amanda Y Sun Madhukar Pai David W Dowdy
author_sort	Henrik Salje
title	The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.
title_short	The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.
title_full	The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.
title_fullStr	The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.
title_full_unstemmed	The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.
title_sort	importance of implementation strategy in scaling up xpert mtb/rif for diagnosis of tuberculosis in the indian health-care system: a transmission model.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/cdff5f30b075414c8862715c13f8a2a8
work_keys_str_mv	AT henriksalje theimportanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT jasonrandrews theimportanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT sarangdeo theimportanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT srinathsatyanarayana theimportanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT amandaysun theimportanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT madhukarpai theimportanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT davidwdowdy theimportanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT henriksalje importanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT jasonrandrews importanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT sarangdeo importanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT srinathsatyanarayana importanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT amandaysun importanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT madhukarpai importanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel AT davidwdowdy importanceofimplementationstrategyinscalingupxpertmtbriffordiagnosisoftuberculosisintheindianhealthcaresystematransmissionmodel
_version_	1718414604687638528

The importance of implementation strategy in scaling up Xpert MTB/RIF for diagnosis of tuberculosis in the Indian health-care system: a transmission model.

Ejemplares similares