Pretreatment attrition after rifampicin-resistant tuberculosis diagnosis with Xpert MTB/RIF or ultra in high TB burden countries: a systematic review and meta-analysis.
| Title: | Pretreatment attrition after rifampicin-resistant tuberculosis diagnosis with Xpert MTB/RIF or ultra in high TB burden countries: a systematic review and meta-analysis. |
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| Authors: | Jouego CG; Molecular Diagnostics Research Group (MDRG), University of Yaoundé 1, Biotechnology Center, Nkolbisson, Cameroon jouego.christelle@gmail.com.; Unit of HIV and Tuberculosis, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium.; Decroo T; Unit of HIV and Tuberculosis, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium.; Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium.; Netongo PM; Molecular Diagnostics Research Group (MDRG), University of Yaoundé 1, Biotechnology Center, Nkolbisson, Cameroon.; Gils T; Unit of HIV and Tuberculosis, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium.; University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium. |
| Source: | BMJ global health [BMJ Glob Health] 2025 Jan 22; Vol. 10 (1). Date of Electronic Publication: 2025 Jan 22. |
| Publication Type: | Journal Article; Systematic Review; Meta-Analysis |
| Language: | English |
| Journal Info: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101685275 Publication Model: Electronic Cited Medium: Print ISSN: 2059-7908 (Print) Linking ISSN: 20597908 NLM ISO Abbreviation: BMJ Glob Health Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group Ltd, [2016]- |
| MeSH Terms: | Rifampin*/therapeutic use ; Rifampin*/pharmacology ; Tuberculosis, Multidrug-Resistant*/diagnosis ; Tuberculosis, Multidrug-Resistant*/drug therapy ; Antibiotics, Antitubercular*/therapeutic use ; Antibiotics, Antitubercular*/pharmacology; Mycobacterium tuberculosis/drug effects ; Humans |
| Abstract: | Introduction: The WHO endorsed the Xpert MTB/RIF (Xpert) technique since 2011 as initial test to diagnose rifampicin-resistant tuberculosis (RR-TB). No systematic review has quantified the proportion of pretreatment attrition in RR-TB patients diagnosed with Xpert in high TB burden countries.Pretreatment attrition for RR-TB represents the gap between patients diagnosed and those who effectively started anti-TB treatment regardless of the reasons (which include pretreatment mortality (death of a diagnosed RR-TB patient before starting adequate treatment) and/or pretreatment loss to follow-up (PTLFU) (drop-out of a diagnosed RR-TB patient before initiation of anti-TB treatment).; Methods: In this systematic review and meta-analysis, we queried EMBASE, PubMed and Web of science to retrieve studies published between 2011 and 22 July 2024, that described pretreatment attrition for RR-TB using Xpert in high TB burden countries. Data on RR-TB patients who did not start treatment after diagnosis and reasons for not starting were extracted in an Excel table. A modified version of the Newcastle-Ottawa scale was used to evaluate the risk of bias among all included studies. The pooled proportion of pretreatment attrition and reasons were assessed using random-effects meta-analysis. Forest plots were generated using R software.; Results: Thirty eligible studies from 21 countries were identified after full-text screening and included in the meta-analysis. Most studies used routine programme data. The pooled proportion of pretreatment attrition in included studies was 18% (95% CI: 12 to 25). PTLFU and pretreatment mortality were, respectively, reported in 10 and nine studies and explained 78% (95% CI: 51% to 92%) and 30% (95% CI: 15% to 52%) of attrition.; Conclusion: Pretreatment attrition was widespread, with significant heterogeneity between included studies. National TB programmes should ensure accurate data collection and reporting of pretreatment attrition to enable reliable overall control strategies.; Prospero Registration Number: CRD42022321509.; (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
| Competing Interests: | Competing interests: None declared. |
| References: | J Clin Microbiol. 2014 Jul;52(7):2422-9. (PMID: 24789181); PLoS One. 2015 Jul 16;10(7):e0132514. (PMID: 26181578); BMC Public Health. 2015 Sep 29;15:980. (PMID: 26415893); PLoS Med. 2014 Dec 09;11(12):e1001766. (PMID: 25490549); BMC Res Notes. 2018 Feb 9;11(1):121. (PMID: 29426372); Sci Rep. 2022 Mar 10;12(1):3912. (PMID: 35273212); PLoS One. 2014 Jul 31;9(7):e103328. (PMID: 25079599); Trop Med Infect Dis. 2023 Jan 02;8(1):. (PMID: 36668938); Int J Tuberc Lung Dis. 2018 Nov 1;22(11):1358-1365. (PMID: 30355417); Int J Tuberc Lung Dis. 2018 Aug 1;22(8):899-904. (PMID: 29991399); Afr J Lab Med. 2023 Feb 06;12(1):1975. (PMID: 36873290); Int J Infect Dis. 2022 Nov;124:81-88. (PMID: 36108960); Bull World Health Organ. 2014 Feb 1;92(2):126-38. (PMID: 24623906); Clin Infect Dis. 2019 Sep 27;69(8):1278-1287. (PMID: 30759187); Int J Infect Dis. 2019 Apr;81:236-243. (PMID: 30776546); Evid Based Ment Health. 2019 Nov;22(4):153-160. (PMID: 31563865); Int J Tuberc Lung Dis. 2016 Jul;20(7):882-9. (PMID: 27287639); Int J Tuberc Lung Dis. 2021 Feb 1;25(2):134-141. (PMID: 33656425); Cochrane Database Syst Rev. 2019 Jun 07;6:CD009593. (PMID: 31173647); BMJ. 2021 Mar 29;372:n71. (PMID: 33782057); Public Health Action. 2016 Jun 21;6(2):122-8. (PMID: 27358806); BMC Health Serv Res. 2018 Dec 17;18(1):973. (PMID: 30558670); Exp Clin Transplant. 2023 Apr;21(4):317-323. (PMID: 37154592); Lancet Reg Health Southeast Asia. 2023 Nov 02;22:100294. (PMID: 38482149); BMC Infect Dis. 2014 Aug 16;14:442. (PMID: 25129689); PLoS One. 2019 Feb 28;14(2):e0213017. (PMID: 30818352); J Clin Tuberc Other Mycobact Dis. 2023 Dec 16;34:100410. (PMID: 38225941); PLoS One. 2020 Aug 5;15(8):e0236057. (PMID: 32756559); PLoS One. 2015 Jun 15;10(6):e0123536. (PMID: 26075722); Bull World Health Organ. 2015 Feb 1;93(2):125-30. (PMID: 25883406); PLoS One. 2013 Oct 29;8(10):e77456. (PMID: 24204834); Syst Rev. 2016 Dec 5;5(1):210. (PMID: 27919275); Sci Rep. 2020 Feb 5;10(1):1917. (PMID: 32024860); PLoS Med. 2017 Feb 21;14(2):e1002238. (PMID: 28222095); Int J Tuberc Lung Dis. 2015 Sep;19(9):1078-83, i-iii. (PMID: 26260829); Trans R Soc Trop Med Hyg. 2022 Dec 2;116(12):1154-1161. (PMID: 35710310); PLoS One. 2015 Jun 25;10(6):e0129155. (PMID: 26110273) |
| Contributed Indexing: | Keywords: PCR; Systematic review; Treatment; Tuberculosis |
| Substance Nomenclature: | VJT6J7R4TR (Rifampin); 0 (Antibiotics, Antitubercular) |
| Entry Date(s): | Date Created: 20250123 Date Completed: 20250123 Latest Revision: 20250624 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11758687 |
| DOI: | 10.1136/bmjgh-2024-015977 |
| PMID: | 39848636 |
| Database: | MEDLINE |
Journal Article; Systematic Review; Meta-Analysis