AIDS 2014: GeneXpert with clinic-based care reduced time to treatment for MDR TB patients in Khayelitsha, South Africa

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AIDS2014postScience Speaks is live-blogging from AIDS 2014 in Melbourne, Australia through the coming week, with updates on research, policy and insights from the 20th International AIDS Conference.

MELBOURNE, AUSTRALIA – Tuberculosis is the leading cause of death in South Africa. In 2012, of 14,000 drug-resistant cases per year only 46 percent of those patients received treatment. Even when patients are identified many wait months to initiate treatment.

On Monday, Helen Cox from the University of Cape Town reported on a study aimed at evaluating the impact of the rapid diagnostic, GeneXpert with providing care in primary care clinics rather than hospitals and the difference in timely treatment access. The ultimate goal of expediting treatment access is to reduce the mortality associated with drug-resistant tuberculosis as well as to reduce community transmission of drug-resistant TB.

Khayelitsha, a settlement of 400,000 people outside of Cape Town is home to about 200 patients with drug-resistant tuberculosis each year. Three quarters of those patients have HIV.  Avoiding hospitalization unless patients were extremely ill, nurses managed patients with drug-resistant TB with daily directly observed therapy in clinics. More than 80 percent of patients initiated treatment, and the combination of GeneXpert and decentralizing TB care cut the time to treatment initiation from 2.5 months to 7 days.

Notably, fewer patients with HIV initiated treatment than patients without HIV because they died before treatment could be initiated. Cox noted that to further reduce mortality, innovation is urgently needed to identify patients with HIV and drug-resistant tuberculosis earlier.

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