Estimating the effect of a rifampicin resistant tuberculosis diagnosis by the Xpert MTB/RIF assay on two-year mortality
Bibliographic Data
| ID | 19591230 |
|---|---|
| Authors | Elise De Vos (0000-0002-8019-4030, University of Antwerp, corresponding author), Daniel Westreich (0000-0003-3069-1650, University of North Carolina at Chapel Hill), Lesley Scott (0000-0003-2458-6344, University of the Witwatersrand), Yara Voss de Lima (0000-0001-6618-3995, Instituto Nacional de Saúde), Wendy Stevens (0000-0002-1684-908X, National Health Laboratory Service), Cindy Hayes (National Health Laboratory Service), Pedro Da Silva (0000-0003-4424-9054, National Health Laboratory Service), Annelies Van Rie (0000-0001-7666-3263, University of Antwerp) |
| Editors | Dione Benjumea-Bedoya |
| Year | 2023 |
| Volume | 3 |
| Issue | 9 |
| Pages | e0001989 |
| Publication date | 2023-09-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | PLOS Global Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2767-3375 • E-ISSN: 2767-3375 |
| Publisher | Public Library of Science (PLoS) (PUBLISHER) |
| DOI | 10.1371/journal.pgph.0001989 |
| PMID | 37656670 |
| OpenAlex | W4386365255 |
| Language | EN |
| References cited | 40 |
Studies assessing patient-centred outcomes of novel rifampicin resistant tuberculosis (RR-TB) diagnostics are rare and mostly apply conventional methods which may not adequately address biases. Even though the Xpert MTB/RIF molecular assay was endorsed a decade ago for simultaneous diagnosis of tuberculosis and RR-TB, the impact of the assay on mortality among people with RR-TB has not yet been assessed. We analysed data of an observational prospective cohort study (EXIT-RIF) performed in South Africa. We applied a causal inference approach using inverse odds of sampling weights to rectify survivor bias and selection bias caused by differing screening guidelines. We also adjusted for confounding using a marginal structural model with inverse probability of treatment weights. We estimated the total effect of an RR-TB diagnosis made by the Xpert assay versus the pre-Xpert diagnostic algorithm (entailing a targeted Line Probe Assay (LPA) among TB-confirmed patients) on two-year mortality and we assessed mediation by RR-treatment initiation. Of the 749 patients diagnosed with RR-TB [247 (33%) by the pre-Xpert diagnostic algorithm and 502 (67%) by the Xpert assay], 42.7% died. Of these, 364 (48.6%) patients died in the pre-Xpert group and 200 (39.8%) in the Xpert group. People diagnosed with RR-TB by the Xpert assay had a higher odds of RR-TB treatment initiation compared to those diagnosed by the targeted LPA-based diagnostic process (OR 2.79; 95%CI 2.19–3.56). Receiving an RR-TB diagnosis by Xpert resulted in a 28% reduction in the odds of mortality within 2 years after presentation to the clinic (OR CI 0.72; 95%CI 0.53–0.99). Causal mediation analysis suggests that the higher rate of RR-TB treatment initiation in people diagnosed by the Xpert assay explains the effect of Xpert on 2-year mortality [natural indirect effect odds ratio 0.90 (95%CI 0.85–0.96). By using causal inference methods in combination with high quality observational data, we could demonstrate that the introduction of the Xpert assay caused a 28% reduction in 2-year odds of mortality of RR-TB. This finding highlights the need for advocacy for a worldwide roll-out of rapid molecular tests. Because the effect is mainly caused by increased RR-TB treatment initiation, health care systems should also ensure timely initiation of effective treatment upon an RR-TB diagnosis
Confounding · Mycobacterium tuberculosis · Observational study · Odds ratio · Pathology · Rifampicin · Tuberculosis · Advanced Causal Inference Techniques · Machine Learning and Algorithms · Medicine · Tuberculosis Research and Epidemiology · Internal Medicine
| Highly cited | No |
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