Pediatrics |

Delay to Diagnosis and Delay to Treatment in South African Children With MDR-TB and HIV FREE TO VIEW

Alfredo Lee Chang, MD; Robert Hicks, BA; Nesri Padayatchi, MD; Babu Sunkari, MD; Allison Wolf, BA; Sarita Shah, MD; Max O'Donnell, MD
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Albert Einstein College of Medicine, Bronx, NY

Chest. 2013;144(4_MeetingAbstracts):783A. doi:10.1378/chest.1704621
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SESSION TITLE: Pediatric Pulmonary Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: There are approximately 500,000 incident tuberculosis (TB) cases in children annually. Multidrug resistant TB (MDR-TB) is a growing epidemic in children in South Africa. Data suggest delay to MDR-TB diagnosis and treatment may be associated with increased mortality in adults but treatment delay in pediatric MDR-TB has not been characterized. We hypothesize that delay to diagnosis of MDR-TB is amenable to reduction with new molecular diagnostics (i.e. GeneXpert) while delay from MDR-TB diagnosis to treatment initiation is not.

METHODS: Retrospective study of consecutive children age <15 years admitted to a public TB specialist hospital in KwaZulu-Natal, South Africa, with culture-confirmed MDR-TB or XDR-TB initiated on TB treatment from January 2009 - June 2010 and followed through July 2012. We defined delay in MDR-TB diagnosis (DxD) as time from TB presentation to diagnostic sputum collection for DST. Delay in MDR-TB treatment (TxD) was defined as between the time from MDR-TB diagnosis to MDR-TB treatment.

RESULTS: 84 children with MDR-TB (N=78) or XDR-TB (N=6) were included; 77% were HIV co-infected (N=64). The median age was 8 years (IQR 4-12). 62 (97%) HIV co-infected children were on anti-retroviral therapy (ART) concurrently. Overall treatment delay (DxD+TxD) occurred in 88% (74/84) of MDR-TB patients with a median delay of 119 days (IQR 88-179). 39% (33/84) of MDR-TB patients experienced DxD delay with a median of 99 days (IQR 55-182). 85% of MDR-TB patients experienced TxD delay with a median of 100 days (IQR 74-137).

CONCLUSIONS: Total delay is common in South African children treated for MDR-TB/HIV. When fully implemented, molecular diagnostics (i.e. Gene Xpert) may reduce DxD, but cannot be expected to reduce TxD which is responsible for more of the overall delay in this cohort. Limitations of this analysis include survival bias, and incompletely characterized prior TB treatment. The association of treatment delay with MDR-TB treatment outcome and HIV-related factors will be further explored in our study.

CLINICAL IMPLICATIONS: DxD delay could be reduced when molecular diagnostics are implemented.

DISCLOSURE: The following authors have nothing to disclose: Alfredo Lee Chang, Robert Hicks, Nesri Padayatchi, Babu Sunkari, Allison Wolf, Sarita Shah, Max O'Donnell

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