Министерство Юстиции
Азербайджанской Республики

The impact of Xpert® MTB/RIF and WHO-reviewed case definition on the number of TB relapse cases registered in the Azerbaijan penitentiary system, Abstract

E Gurbanova,1 К Blondal,2 R Mekhdiyev,1 RTahirli,3 F Huseynov,1 N Kerimova,4 F Mirzayev,5 A Altraja6

1Main Medical Department of the Ministry of Justice, Baku, Azerbaijan;
2Department of Communicable Disease Prevention and Control, Reykjavik Health Care Services, Reykjavik, Iceland;
3Laboratory of the Specialized Treatment Institution for Detainees with Tuberculosis, Baku,
4Project Implementation Unit, Main Medical Department of the Ministry of Justice, Baku, Azerbaijan;
5Laboratories, Diagnostics & Drug Resistance Unit, World Health Organization, Geneva, Switzerland;
6Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia,
e-mail: e.gurbanova@prisonhealth.az

Source: Abstract Book, 46th World International Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease

Background: The Main Medical Department of Azerbai­jan Ministry of Justice implements an exemplary ТВ Control programme in the penitentiary system (PS) providing up-to-date diagnostics and effective treatment for inmates with both susceptible and drug-resistant ТВ in the Special Treatment Institution (STI). The STI also houses a modern quality-assured reference laboratory that performs all WHO-recommended diagnostics of ТВ. In 2013, Xpert MTB/RIF assay was introduced as a routine diagnostic algorithm in STI along with adopting the reporting system to the Reviewed WHO Case Definitions Framework.

Objectives: To assess the impact of introduction of Xpert MTB/RIF assay to the diagnostic algorithm of ТВ and the impact of the use of the reviewed WHO definition of ТВ cases on the number of registered relapse cases in Azerbaijan PS. Design and methods: A cohort of all new and previously treated cases with pulmonary and extra-pulmonary ТВ that started treatment with the first line (FI.D) and second line drugs (SLD) in the PS of Azerbaijan during 01.01.2007-13.02.2015 was includ­ed. The cohort was divided into 2 groups: Group 1: cases enrolled during 01.01.2007-31.12.2012 and Group 2: cases enrolled during 01.01.2013-13.02.2015 (i.e. before and after the Introduction of Xpert MTB/RIF to the diagnostic algorithm of ТВ and use of the new WHO Case Definition Framework (Table). Logistic regression analysis was used to determine the association of registered relapse cases with the introduction of Xpert MTB/RIF and use of the new definition.

Results: In the Group 2, 31% (57) out of all 180 relapse cases were due to diagnosis with Xpert MTB/RIF only (n = 27) and new WHO case definition introduction (n = 30). Among patients diagnosed with Xpert MTB/RIF only, the average duration between the end of most recent treatment course and the recurrent episode was 31 months. The number of relapse cases significantly increased in the overall cohort: OR 1.5 (95%CI 1.2- 1.8, P < 0.001) and in patients on treatment with FLD: OR 1.5 (95%CI 1.2-1.9, P < 0.001). There was no significant increase of relapse cases among the patients treated with SLD.

Conclusions: Introduction of Xpert MTB/RIF to the diagnostic algorithm of ТВ and use of the new WHO Case Definition Framework significantly increase the number of ТВ cases registered as relapse in the Azerbaijan PS.