Sécurité Transfusionnelle à l’Hôpital Général de Référence Dr Rau/Ciriri, à l’Est de la République Démocratique du Congo

Objectif : La présente étude avait pour objectif de décrire le profil de la sécurité transfusionnelle à l’Hôpital General de Référence Dr Rau de Ciriri.Méthodes : Une étude transversale rétrospective a été conduite du 1er janvier au 31 juin 2012 auprès des donneurs de sang fréquentant le service de laboratoire de l’Hôpital General de Reference Dr Rau de Ciriri.Résultats : Les séroprévalences globales des marqueurs du virus de l’immunodéficience humaine, des virus des hépatites B et C, et de la syphilis chez les donneurs de sang étaient respectivement de 1,1%, 3,8%, 0,7% et 0,0%. Ces séroprévalence étaient plus élevée dans la catégorie des donneurs familiaux et nouveaux. Aucune investigation n’avait été réalisée chez les donneurs avant le don de sang. Les qualifications immunologique et biologique des poches de sang étaient incomplètes et certaines poches de sang étaient transfusées sans les résultats des marqueurs des virus des hépatites B et C, et de la syphilis.Conclusions : La sécurité transfusionnelle demeure un problème de santé à l’Hôpital Général de Référence Dr Rau de Ciriri. Une sensibilisation de la population sur le don bénévole de sang, une sélection médicale des donneurs et des qualifications immunologique et biologique complètes pourraient réduire les risques transfusionnels dans cette structure sanitaire

Xpert mycobacterium tuberculosis/rifampicin-detected rifampicin resistance is a suboptimal surrogate for multidrug-resistant tuberculosis in Eastern Democratic Republic of the Congo : diagnostic and clinical implications

CITATION: Bisimwa, B. C. et al. 2020. Xpert Mycobacterium tuberculosis/Rifampicin–Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications. Clinical Infectious Diseases, 73(2):e362–e370. doi:10.1093/cid/ciaa873The original publication is available at https://academic.oup.com/cid/Background Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDRplus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)–detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC). Methods We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDRplus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy. Results Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDRplus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDRplus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDRplus-detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1–100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5–72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively. Conclusions In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting.https://academic.oup.com/cid/article/73/2/e362/5863452?login=truePublishers versio

Lessons learned from early implementation of GeneXpert MTB/RIF technology in a remote area of the Democratic Republic of Congo

Democratic Republic of Congo (DRC) has the second highest burden of smear-positive tuberculosis (TB) in Africa yet many cases go undetected. In the South-Kivu Province, this may be closely related to conflicts and difficult access to health services. Through a TB REACH grant, we addressed low case detection and identification of drug resistance through GeneXpert MTB/Rif technology (GXP). GXP is a molecular test that can be used at lower levels of health services, has a high sensitivity and a turn-around time of 2 hours. In addition, this assay permits to identify Rifampicin resistance. There is little experience using GXP in programmatic settings in DRC. Material and methods Eight GXP machines (consisting of 18 total modules) were placed in 2 referral/academic laboratories, 5 secondary hospitals and one urban primary health care facility. No lab technician had used PCR techniques before training. Device setting and training of lab technicians were performed on-site during 3 consecutive days. In addition, each laboratory was equipped with appropriate electrical power to be able to perform 4 runs of tests per module/day. GXP testing was performed on patients clinically suspected of TB with at least 3 negative Ziehl-Neelsen microscopy tests. Results During the first year evaluation period, 8.614 tests were performed among smear-negative sputum samples. Each module performed on average 19,4 tests per month during the first semester and 45 tests per month during the second semester. The positivity rate of GXP tests performed among smear negative samples was 7,2% (n = 624). Rif resistance was detected among 31 samples, and 20 patients received second line treatment. Two of these patients (10%) died within the 1-year follow-up. Error rates was 9,6% (n = 827). Before one year of use, 7 out of 18 modules (39%) had to be replaced for technical reasons, including unexplained high error rates. Discussion GXP technology can be successfully implemented in settings with very limited resources. In South-Kivu, considering a general positivity rate of 13,6% for smear microscopy, GXP improved bacteriologically confirmed case notification by 50% in areas where this test was available. Detection of drug resistant cases surged and demonstrates that many resistant cases are missed with the current algorithm. Maintenance issues and continuous monitoring of error rates are crucial and should be improved before scale-up of GeneXpert at a country-level

Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF-identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012-2017: A Retrospective Province-Wide Cohort Study

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) jeopardizes global TB control. The prevalence and predictors of Rifampicin-resistant (RR) TB, a proxy for MDR-TB, and the treatment outcomes with standard and shortened regimens have not been assessed in post-conflict regions, such as the South Kivu province in the eastern Democratic Republic of the Congo (DRC). We aimed to fill this knowledge gap and to inform the DRC National TB Program. METHODS: of adults and children evaluated for pulmonary TB by sputum smear microscopy and Xpert MTB/RIF (Xpert) from February 2012 to June 2017. Multivariable logistic regression, Kaplan-Meier estimates, and multivariable Cox regression were used to assess independent predictors of RR-TB and treatment failure/death. RESULTS: Of 1535 patients Xpert-positive for TB, 11% had RR-TB. Independent predictors of RR-TB were a positive sputum smear (adjusted odds ratio [aOR] 2.42, 95% confidence interval [CI] 1.63-3.59), retreatment of TB (aOR 4.92, 95% CI 2.31-10.45), and one or more prior TB episodes (aOR 1.77 per episode, 95% CI 1.01-3.10). Over 45% of RR-TB patients had no prior TB history or treatment. The median time from Xpert diagnosis to RR-TB treatment initiation was 12 days (interquartile range 3-60.2). Cures were achieved in 30/36 (83%) and 84/114 (74%) of patients on 9- vs 20/24-month MDR-TB regimens, respectively (P = .06). Predictors of treatment failure/death were the absence of directly observed therapy (DOT; adjusted hazard ratio [aHR] 2.77, 95% CI 1.2-6.66) and any serious adverse drug event (aHR 4.28, 95% CI 1.88-9.71). CONCLUSIONS: Favorable RR-TB cure rates are achievable in this post-conflict setting with a high RR-TB prevalence. An expanded Xpert scale-up; the prompt initiation of shorter, safer, highly effective MDR-TB regimens; and treatment adherence support are critically needed to optimize outcomes

Xpert Mycobacterium tuberculosis/Rifampicin-Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications

BACKGROUND: Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDRplus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)-detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC). METHODS: We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDRplus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy. RESULTS: Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDRplus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDRplus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDRplus-detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1-100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5-72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively. CONCLUSIONS: In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe