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The potential impact of up-front drug sensitivity testing on India's epidemic of multi-drug resistant tuberculosis

Title: The potential impact of up-front drug sensitivity testing on India's epidemic of multi-drug resistant tuberculosis
Authors: Sachdeva, KS
Raizada, N
Gupta, RS
Nair, SA
Denkinger, C
Paramasivan, CN
Kulsange, S
Thakur, R
Dewan, P
Boehme, C
Arinaminpathy, N
Item Type: Journal Article
Abstract: Background In India as elsewhere, multi-drug resistance (MDR) poses a serious challenge in the control of tuberculosis (TB). The End TB strategy, recently approved by the world health assembly, aims to reduce TB deaths by 95% and new cases by 90% between 2015 and 2035. A key pillar of this approach is early diagnosis of tuberculosis, including use of higher-sensitivity diagnostic testing and universal rapid drug susceptibility testing (DST). Despite limitations of current laboratory assays, universal access to rapid DST could become more feasible with the advent of new and emerging technologies. Here we use a mathematical model of TB transmission, calibrated to the TB epidemic in India, to explore the potential impact of a major national scale-up of rapid DST. To inform key parameters in a clinical setting, we take GeneXpert as an example of a technology that could enable such scale-up. We draw from a recent multi-centric demonstration study conducted in India that involved upfront Xpert MTB/RIF testing of all TB suspects. Results We find that widespread, public-sector deployment of high-sensitivity diagnostic testing and universal DST appropriately linked with treatment could substantially impact MDR-TB in India. Achieving 75% access over 3 years amongst all cases being diagnosed for TB in the public sector alone could avert over 180,000 cases of MDR-TB (95% CI 44187 – 317077 cases) between 2015 and 2025. Sufficiently wide deployment of Xpert could, moreover, turn an increasing MDR epidemic into a diminishing one. Synergistic effects were observed with assumptions of simultaneously improving MDR-TB treatment outcomes. Our results illustrate the potential impact of new and emerging technologies that enable widespread, timely DST, and the important effect that universal rapid DST in the public sector can have on the MDR-TB epidemic in India.
Issue Date: 1-Jul-2015
Date of Acceptance: 2-Jun-2015
URI: http://hdl.handle.net/10044/1/51061
DOI: https://dx.doi.org/10.1371/journal.pone.0131438
ISSN: 1932-6203
Publisher: Public Library of Science
Journal / Book Title: PLOS One
Volume: 10
Issue: 7
Copyright Statement: © 2015 Sachdeva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor/Funder: Medical Research Council (MRC)
Bill & Melinda Gates Foundation
Funder's Grant Number: MR/K010174/1B
OPP1095710
Keywords: Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
HUMAN-IMMUNODEFICIENCY-VIRUS
PULMONARY TUBERCULOSIS
SURVEILLANCE
POPULATION
PREVALENCE
DIAGNOSIS
DELAYS
STATE
CARE
Antitubercular Agents
Epidemics
Humans
Incidence
India
Microbial Sensitivity Tests
Models, Theoretical
Prevalence
Tuberculosis, Multidrug-Resistant
MD Multidisciplinary
General Science & Technology
Publication Status: Published
Article Number: ARTN e0131438
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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