Reducing delays to multidrug-resistant tuberculosis case detection through a revised routine surveillance system

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Systems Strengthening

Background:

• Tuberculosis surveillance in low-income countries faces challenges, including long delays in specimen transport and results dissemination.
• These delays impede effective patient management, especially for multidrug-resistant tuberculosis.
• An effective surveillance system is essential for controlling tuberculosis, particularly drug-resistant strains.

Purpose of the Study:

• To evaluate a revised Tuberculosis Routine Surveillance System in Mwanza, Tanzania.
• To assess the impact of rapid molecular diagnostics and improved communication on tuberculosis and drug resistance detection.
• To reduce delays in specimen transportation and results feedback.

Main Methods:

• A pilot intervention was implemented in Mwanza, Tanzania, involving rapid molecular methods (Xpert MTB/RIF) and Line Probe Assay.
• A revised communication strategy, including mobile applications, was introduced.
• A before-and-after comparison assessed changes in drug-resistant tuberculosis case identification and feedback times.

Main Results:

• The number of previously treated cases tested increased from 75 in 2016 to 185 in 2017.
• Specimen transportation time decreased by 22%, and median results feedback time reduced by 36%.
• The number of drug-resistant tuberculosis cases initiating treatment rose by 67%.

Conclusions:

• New technologies and improved surveillance systems, coupled with mobile communication, can enhance drug resistance detection and reduce delays.
• The findings suggest that these improvements significantly benefit tuberculosis control efforts.
• Further large-scale studies are recommended to validate these benefits across diverse settings.