Effects of Xpert® MTB/RIF testing and GxAlert on MDR-TB diagnosis and linkage to care in Mozambique

SETTING : The diagnosis of multidrug-resistant tuberculosis (MDR-TB) and gaps in linkage to care are the principal health challenges in Mozambique. Five Gene-Xpert machines and GxAlert, an eHealth platform, were installed in Sofala and Manica Provinces between 2012 and 2014. OBJECTIVE: To test the effects of Xpert (R) MTB/RIF testing and GxAlert on rifampin-resistant TB (RR-TB) diagnosis and second-line treatment initiation rates. DESIGN: We conducted a retrospective clinical review of patients with RR-TB from March 2012 to September 2015 at these five sites. Time-series analyses were conducted to investigate the impact of Xpert on case detection and treatment. Pre- and post- analyses were conducted to investigate the impact of GxAlert. RESULTS: A total of 32 182 Xpert tests were conducted: 4010 (12.5%) detected TB without rifampin resistance, and 306 (7.1%) had RR-TB. Of the RR-TB cases, 161 (52.6%) were started on MDR-TB treatment, 6.9% had documented culture results, and time from diagnosis to treatment initiation decreased over time. The absolute number of patients diagnosed and started on MDR-TB treatment increased by 0.26 (95% 0.15-0.38, P < 0.001) and 0.16 (95%CI 0.089-0.24, P < 0.001) every 6 months. GxAlert did not affect treatment initiation rates. CONCLUSION: Implementation of Xpert testing was associated with increases in the number of patients diagnosed and started on MDR-TB treatment.