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Table 1 Study characteristics and time delays reported for diagnosis and treatment of drug-sensitive TB

From: Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis

Author

Year

Country

Study design

Setting

Level of healthcare system

HIV prevalence

       

Boehme [30]

2011

Multipleb

Pre/post

Urban

Mixed

0.19

       

Yoon [50]

2012

Uganda

Pre/post

Urban

Tertiary

0.76

       

Kwak [51]

2013

South Korea

Observational

Urban

Tertiary

0.27

       

Chaisson [52]

2014

USA

Hypothetical

Urban

Tertiary

NR

       

Cohen [53]

2014

South Africa

Observational

Urban

Tertiary

1.00

       

Cox [54]

2014

South Africa

Parallel Cl. RCT

Urban

Primary

0.60

       

Durovni [32]

2014

Brazil

St.-we CI. RCT

Urban

Primary

0.10

       

Mupfumi [34]

2014

Zimbabwe

Ind. RCT

Urban

Tertiary

1.00

       

Sohn [55]

2014

Canada

Hypothetical

Urban

Tertiary

0.02

       

Theron [37]

2014

Multiplea

Ind. RCT

Urban

Primary

0.6

       

Calligaro [56]

2015

South Africa

Observational

Urban

Tertiary

0.27

       

Muyoyeta [57]

2015

Zambia

Observational

Urban

Primary

0.52

       

Page [35]

2015

Cambodia

Observational

NR

NR

NR

       

Page [35]

2015

Kenya

Observational

NR

NR

NR

       

Page [35]

2015

Swaziland

Observational

NR

NR

NR

       

van den Handel [58]

2015

South Africa

Observational

Rural

Primary

0.28

       

Hanrahan [59]

2016

Uganda

Observational

NR

NR

0.69

       

Akanbi [60]

2017

Nigeria

Observational

Urban

Tertiary

1.00

       

Calligaro [61]

2017

South Africa, Zimbabwe

Randomized, parallel group trial

Urban

Primary

0.58

       

Mwansa-Kambafwile [62]

2017

South Africa

Observational

Urban

Primary

0.73

       

Schmidt [63]

2017

South Africa

Observational

Rural

Primary

NR

       

Shete [36]

2017

Uganda

Single arm interventional pilot

Rural

Primary

0.53

       

de Castro [64]

2018

Brazil

Observational

Urban

Primary

0.05

       

Khumsri [65]

2018

Thailand

RCT

Urban

Tertiary

NR

       

Mugauri [66]

2018

Zimbabwe

Observational

Urban

Primary

NR

       

Agizew [67]

2019

Bostwana

St.-we CI. RCT

NR

Primary

1

       

Le [68]

2019

Vietnam

Observational

Rural

Tertiary

NR

       

Nalugwa [69]

2020

Uganda

Observational

NR

Tertiary

0.838

       

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

1429

1 day (0–2)

3659

Smear: 2 days (2–3)

Culture: 58 days (42–62)

Time to detection

Collection of first sputum to receiving result by clinicians

1907

5 daysd (2–8)

4734

56 days (39–81)

Time to treatment initiation

First sputum collection to time to treatment initiation

Yoon [50]

2012

190

Same day (0–1)

246

1 day (0–26)

Time to detection

Enrolment to first positive result

190

6 daysd (1–61)

246

7 days (3–53)

Time-to-TB treatment

Enrolment to treatment initiation

Kwak [51]

2013

681

6 days (3–7)

681

Smear: 12 days (7–19.25)

Culture: 38.5 (35.75–50.25)

Time to confirmation of receipt of results

Request of diagnostic test to confirmation of results by duty physician

43

7 days (4–9)

86

21 days (7–33.5)

Time to anti-TB treatment

Request of diagnostic test to initiation of ATT

Chaisson [52]

2014

142

1 day (0–2)

142

2 days (1–4)

Time to result

Order for admission to time to reporting results

NR

NR

NR

NR

NR

NR

Cohen [53]

2014

156

6.3 days (5.3–8.1)

90

3.3 days (2.1–5.2)

Total diagnostic time

Sputum collection to clinician receipt of result

NR

NR

NR

NR

NR

NR

Cox [54]

2014

NR

NR

NR

NR

NR

NR

982

4 days (2–8)

1003

8 days (2–27)

Time to TB treatment initiation

Enrolmentc to treatment initiation

Durovni [32]

2014

1385

7.3 days (3.4–9.0)

831

7.5 days (4.9–10.0)

Time to positive result

Specimen processing to lab-confirmed TB notification

1385

8.1 days (5.4–9.3)

831

11.4 days (8.5–14.5)

Time to treatment initiation

NR

Mupfumi [34]

2014

214

2 days (1–13)

210

6 days (1–25)

Time to diagnosis

Clinical presentation (baseline visit) to TB diagnosis

214

5 days (3–13)

210

8 days (3–23)

Time to treatment initiation

Clinical presentation (baseline visit) to treatment initiation

Sohn [55]

2014

11

1 day (0–4)

11

Smear: 1 day (1–2)

Culture: 21.5 days (14–30)

Time to diagnosis

Time between first sample and the positive Xpert result

11

Hypothetically reduce by 12 days (4–23) in smear negative TB patient

11

26 days (4–30)

Time to reporting

Time from first sample to treatment initiation

Theron [37]

2014

NR

81% diagnosed on same day

NR

43% diagnosed on same day

NR

NR

744

Same day (0–3)

758

1 day (0–4)

Time to treatment

Enrolmentc to treatment initiation

Calligaro [56]

2015

111

0.2 days (0.2–0.3)

115

12.1 days (0.3–22.2)

Time to diagnosis

NA

111

0.3 days (0.2–1.2)

115

0.7 days (0.2–2.2)

Time to initiation of treatment

NR

Muyoyeta [57]

2015

NR

NR

NR

NR

NR

NR

553

2 days (1–5)

212

3 days (2–6)

Time to TB treatment

Date to first presentation to diagnostic services to date pt. was commenced on TB treatment

Page [35]

2015

NR

NR

NR

NR

NR

NR

15

16 days (6–33)

77

4 days (2–6)

Delay in treatment initiation

Collection of first specimen and treatment start

Page [35]

2015

NR

NR

NR

NR

NR

NR

17

4 days (2–7)

3

1 day (1–35)

Page [35]

2015

NR

NR

NR

NR

NR

 

63

6.5 days (3–10)

7

8 days (1–11)

van den Handel [58]

2015

NR

NR

NR

NR

NR

NR

75

1 day (0–2)

68

11.5 days (6–24)

Time to treatment

First sputum sample collection to anti-TB treatment initiation

Hanrahan [59]

2016

NR

NR

NR

NR

NR

NR

48

0 days (0–0)

39

Empiric: 14 days (5–35)

Culture: 144 days (28–180)

Time to treatment

Sputum collection to TB treatment

Akanbi [60]

2017

NR

NR

NR

NR

NR

NR

56

5 days (2–8)

20

12 days (5–35)

Time to treatment

Baseline visit (specimen collection) to treatment initiation

Calligaro [61]

2017

NR

NR

NR

NR

NR

NR

435

1 day (0.1–4)

413

4 days (1–31)

Time-to-treatment initiation

Enrolment to initiated on treatment

Mwansa-Kambafwile [62]

2017

NR

NR

NR

NR

NR

NR

177

0 days (0–0)

21

9 days (4–20)

Time to treatment initiation

NR to treatment initiation

Schmidt [63]

2017

851

0 days (0–1)

738

2 days (1–22)

Time to laboratory diagnosis

Sputum sample collection to test result reported

851

4 days (2–8)

NR

NR

Time to TB treatment initiation

Time from sputum sample collection to time when TB treatment was recorded as being initiated

Shete [36]

2017

1091

1 day (0–2)

54

1 day (0–2)

Time-to-diagnosis

NR

41

6 days (2–11)

113

1 day (0–1)

Time-to-treatment

NR

de Castro [64]

2018

24

6 days (2–8)

41

3 days (2–6)

Time from triage to NR

Triage to lab test result release

24

14.5 days (8–28)

41

8 days (6–12)

Time from triage to NR

Triage to treatment initiation

Khumsri [65]

2018

40

1.88e (SD 1.07)

36

4.11e (SD 2.22)

Time to get correct diagnosis

Outpatient department visit to receive correct diagnosis

NR

NR

NR

NR

NR

NR

Mugauri [66]

2018

NR

NR

NR

NR

NR

NR

340

20.17 dayse (SD 10.3)

318

22.44 dayse (SD 30.2)

Delay in treatment initiation from diagnosis

Diagnosis to treatment initiation

Agizew [67]

2019

NR

NR

NR

NR

NR

NR

159

6 days (2–17)

42

22 days (3–51)

Time-to-treatment

Sputum collection to treatment initiation

Le [68]

2019

69

2 days (1–4)

NR

NR

NR

NR

69

1 day (0–1)

8

3 days (1–8)

Time to anti-TB treatment

Hospital admission to treatment initiation

Nalugwa [69]

2020

NR

NR

NR

NR

NR

NR

33

2 days (0–14)

NR

0 days (0–1)

Time to treatment

NR to treatment initiation

  1. Page 2015 reported time delay for 4 different sites, 3 of which were included in the analysis as individual studies; the one remaining site did not have time delay data on smear and was excluded from the primary analysis
  2. van den Handel 2015 compared Xpert in both centralized and decentralized settings with smear, and they were also separately included in the analysis
  3. POCT programs were generally defined by each study as performing Xpert testing by non-laboratory personnel within the TB clinic
  4. 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
  5. Ind. RCT: Individually Randomized Controlled Trial; Cl. RCT: Cluster Randomized Controlled Trial; St.-we. Cl. RCT: stepped-wedge Cluster Randomized Controlled Trial; pre/post: pre/post implementation study; hypothetical: single-cohort hypothetical study; observational: single-cohort observational study; POCT: point-of-care testing; TB: tuberculosis; MDR: multidrug-resistant tuberculosis; NR: not reported
  6. aSouth Africa, Peru, India, Azerbaijan, Philippines, and Uganda
  7. bSouth Africa, Zimbabwe, Zambia, and Tanzania
  8. cEstimated based on study design
  9. dIn smear negatives
  10. eReported means and standard deviations
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BMC Infectious Diseases

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