Table 2.
Study characteristics and time delays reported for diagnosis and treatment of drug-resistant TB
| Author | Year | Country | Study design | Setting | Level of healthcare system | HIV prevalence | Type of culture | Type of LPA | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Boehme [30] | 2011 | Multiplea | Observational | Urban | Mixed | 0.19 | Both | Both | |||||
| Chryssanthou [70] | 2011 | Sweden | Observational | Urban | Tertiary | NR | Liquid culture | Direct | |||||
| Skenders [71] | 2011 | Latvia | Observational | NR | NR | NR | Liquid culture | Direct | |||||
| Hanrahan [40] | 2012 | South Africa | Observational | NR | NR | 0.58 | Liquid culture | Both | |||||
| Jacobson [72] | 2012 | South Africa | Observational | Rural | Tertiary | 0.30 | Liquid culture | Indirect | |||||
| Lyu [73] | 2013 | South Korea | Observational | Urban | Tertiary | 0.01 | Liquid culture | Direct | |||||
| Gauthier [74] | 2014 | Haiti | Observational | Urban | Tertiary | NR | Solid culture | Direct | |||||
| Liquid culture | |||||||||||||
| Kipiani [75] | 2014 | Georgia | Observational | Urban | Tertiary | 0.03 | Solid culture | Direct | |||||
| Raizada [76] | 2014 | India | Observational | Urban | NR | NR | Solid culture | Direct | |||||
| Singla [77] | 2014 | India | Observational | Urban | Tertiary | NR | Both | Direct | |||||
| Bablishvili [78] | 2015 | Georgia | Observational | Urban | Tertiary | NR | Solid culture | Direct | |||||
| Liquid culture | |||||||||||||
| Cox [39] | 2015 | South Africa | Observational | Urban | Primary | 0.74 | Both | Direct | |||||
| Eliseevb [79] | 2016 | Russia | Observational | NR | NR | 0.06 | Solid culture | Direct | |||||
| Liquid culture | |||||||||||||
| Evans [80] | 2017 | South Africa | Observational | Urban | Tertiary | 0.89 | NR | NR | |||||
| Iruedo [81] | 2017 | South Africa | Observational | Rural | Primary | 0.61 | NR | NR | |||||
| Evans [82] | 2018 | South Africa | Observational | Urban | Primary | 0.26 | NR | NR | |||||
| Lib,c [43] | 2019 | China | Observational | Urban | Tertiary | NR | Solid culture | Direct | |||||
| Jeon [41] | 2020 | South Korea | Observational | Urban | Tertiary | NR | NR | NR | |||||
| Ngabonziza [83] | 2020 | Rwanda | Observational | NR | Tertiary | 0.40 | NR | NR | |||||
| Shi [42] | 2020 | China | Observational | Urban | Tertiary | NR | Solid culture | Direct |
| Author | Year | Diagnostic delay | Treatment initiation delay | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Index | Comparator | Term | Time period | Index | Comparator | Term | Time period | ||||||
| n | Median (IQR) (days) | n | Median (IQR) (days) | n | Median (IQR) (days) | n | Median (IQR) (days) | ||||||
| Boehme [30] | 2011 | 244 | 63 (38–102) | 356 | 40 (27–53) | Time to detection | Specimen collection to receiving result by clinicians | NR | NR | NR | NR | NR | NR |
| Chryssanthou [70] | 2011 | 127 | 21 (13–78) | 127 | 7 (1–16) | Lab processing time | Specimen arrival at lab to report of DST to clinician | NR | NR | NR | NR | NR | NR |
| Skenders [71] | 2011 | NR | NR | NR | NR | NR | 47 | 40 (23–67) | 22 | 14 (7–22) | Admission to treatment start | Hospital admission to treatment start | |
| Hanrahan [40] | 2012 | 1176 | 52 (41–77) | 1177 | 26 (11–52) | Test turnaround time | Date of sputum collection to DST results | 26 | 78 (52–93) | 52 | 62 (32–86) | Time to MDR-TB treatment | Date of sputum collection to MDR-TB treatment |
| Jacobson [72] | 2012 | 89 | 55 (46–66) | 108 | 27 (20–34) | Lab processing time | Specimen arrival at lab to report of results | 89 | 80 (62–100) | 108 | 55 (37.5–78) | Time to MDR treatment initiation | Specimen collection to MDR treatment initiation |
| Lyu [73] | 2013 | 428 | 83 (68–92) | 168 | 12.7 (8–17) | Turnaround time | Test request to reporting of results | NR | NR | NR | NR | NR | NR |
| Gauthier [74] | 2014 | 221 | 54 (43–64) | 221 | 7.5 (6.5–8.5) | Turnaround time | NR to time to positivity | NR | NR | NR | NR | NR | NR |
| 221 | 19 (12–25) | 221 | 7.5 (6.5–8.5) | Turnaround time | NR to time to positivity | NR | NR | NR | NR | NR | NR | ||
| Kipiani [75] | 2014 | NR | NR | NR | NR | NR | 72 | 83.9 (56–106) | 80 | 18.2 (11–24) | Time to MDR-TB treatment initiation | Sputum collection to start of SLD therapy | |
| Raizada [76] | 2014 | 248 | 87 (42–208) | 248 | 11 (1–76) | Turnaround testing time | Specimen collection to DST result being available | NR | NR | NR | NR | NR | NR |
| Singla [77] | 2014 | 121 | 107 (79–131) | 433 | 5 (3–6) | Diagnostic time in lab | Specimen arrival at lab to MDR-TB report | 51 | 157 (127–200) | 83 | 38 (30–79) | NR | Time from identification patients suspected for MDR-TB to MDR-TB treatment initiation |
| Bablishvili [78] | 2015 | 155 | 33 (27–41) | 336 | 5 (3–7) | Time to MTB detection | Sample collection to recorded results | NR | NR | NR | NR | NR | NR |
| 227 | 9 (7–11) | 336 | 5 (3–7) | Time to MTB detection | Sample collection to recorded results | NR | NR | NR | NR | NR | NR | ||
| Cox [39] | 2015 | NR | NR | NR | NR | NR | NR | 95 | 76 (62–111) | 173 | 28 (16–40) | Time to treatment | Time from collection to treatment initiation |
| Eliseevb [79] | 2016 | NR | NR | NR | NR | NR | NR | 38 | 90 (76.3–117.3) | 72 | 24 (19–51) | Time to MDR-TB treatment initiation | First visit to treatment |
| NR | NR | NR | NR | NR | NR | 58 | 74 (55–99.8) | 72 | 24 (19–51) | Time to MDR-TB treatment initiation | First visit to treatment | ||
| Evans [80] | 2017 | NR | NR | NR | NR | NR | NR | 256 | 81 (49–115) | 256 | 38 (23–54) | NR | Sputum collection to treatment initiation |
| Iruedo [81] | 2017 | 143 | 45 (39–59) | 28 | 11.5 (8–21) | Time to diagnosis | Sputum collection to issue of report to clinic | 143 | 64 (50–103) | 28 | 29 (14.5–53) | Time to treatment | Sputum collection to treatment initiation |
| Evans [82] | 2018 | NR | NR | NR | NR | NR | NR | 7 | 81 (28–97) | 129 | 38 (23–51) | Time to treatment initiation | Specimen collection to treatment initiation |
| Lib,c [43] | 2019 | 155 | 53 (49–60) | 155 | 3 (2–4) | Turnaround time | Sample receipt to reporting date of results | NR | NR | NR | NR | NR | NR |
| Jeon [41] | 2020 | NR | NR | NR | NR | NR | NR | 263 | 13 (5–25) | 202 | 5 (2–9.3) | Time to MDR treatment initiation | MDR-TB diagnosis to MDR-TB treatment initiation |
| Ngabonziza [83] | 2020 | 313 | 87 (78–98) | 197 | 40 (25–55) | RR-TB diagnostic delay | Specimen collection to results being available | NR | NR | NR | NR | NR | NR |
| Shi [42] | 2020 | 105 | 62 (53–69) | 113 | 16 (10–19) | NR | NR | 37 | 69 (59–77) | 42 | 19 (14–23) | NR | NR |
Evans 2017 compares different diagnostic methods within the cohort, whereas Evans 2018 compares cohort analysed in Evans 2017 with a later cohort
Countries were classified using the World Bank classification based on gross national income (GNI) in 2015 for studies that were included in the original search and 2020 for studies included in the updated search
LPA line probe assay, IQR interquartile range, NR not reported, DST drug susceptibility testing, MDR multidrug resistance, SLD second line drug therapy, RR-TB rifampin-resistant TB, MTB mycobacterium tuberculosis
aSouth Africa, Zimbabwe, Zambia, and Tanzania
bEstimates only for sputum smear positive patients
cReported means and standard deviations