The Role of GeneXpert MTB/RIF in Reducing Treatment Delay Among Multidrug Resistance Tuberculosis Patients: A Propensity Score Matched Analysis

Figures & data

Table 1 Socio-Demographic and Behavioral Characteristics of Drug-Resistant Tuberculosis MDR-TB Patients in Amhara Region, Ethiopia (N = 465)

Variables	Frequency (%)
Age
<24	155 (33.3)
25–34	145 (31.2)
35–44	89 (19.2)
>45	76 (16.3)
Sex
Male	270 (58)
Female	195 (42)
Education status
No formal education	195 (42)
Primary	145 (31.2)
Secondary	81 (17.4)
Diploma and above	44 (9.4)
Residence
Urban	223 (48)
Rural	242 (52)
Treatment supporter
Yes	396 (85.2)
No	69 (14.8)
Substance use history
Alcohol intake	88 (18.9)
Cigarette smoking	60 (12.9)
Khat chewing	40 (8.6)
Occupation
Unemployed	188 (40.4)
Working in governmental or private	277 (59.6)
Organizations

Table 2 Clinical Characteristics of Drug-Resistant Tuberculosis MDR-TB Patients in Amhara Region, Ethiopia (N = 465)

Characteristics	Frequency (%)
Body mass index
Under weight	129 (27.7)
Normal	332 (71.4)
Overweight	4 (0.9)
Form of TB
Pulmonary	430 (92.5)
Extrapulmonary	35 (7.5)
TB/HIV co-infection
Yes	118 (25.4)
No	347 (74.6)
Registration group
New	59 (12.7)
Previously treated	406 (87.3)
Presenting symptoms
Cough	419 (90.1)
Fever	434 (93.3)
Chest pain	313 (67.3)
Excessive sputum production	27 (5.8)
Weight loss	421 (90.5)
Anorexia	345 (74.2)
Fatigue	357 (76.8)
Laboratory investigations
GeneXpert	217 (46.7)
LPA	167 (35.9)
Culture and DST	81 (17.4)
Comorbidities (n=42)
Diabetes Mellitus	12 (28.6)
Hypertension	5 (11.9)
Bronchial asthma/COPD	18 (42.8)
Cardiac illnesses	7 (16.7)

Abbreviations: COPD, chronic obstructive pulmonary disease; DST, drug susceptibility tests; LPA, line probe assay.

Table 3 Binary Logistic Regression Model to Identify Factors Associated with Treatment Delay Among DR-TB Patients in Amhara Region, Ethiopia (N = 465)

Variables	Treatment Delay		Adjusted Odds Ratio (95% CI)	P-value
	Yes	No
Sex of patient
Male	144	122	1
Female	96	94	0.76 (0.49 1.19)	0.48
Residence
Urban	114	104	1
Rural	126	112	0.98 (0.63 1.50)	0.98
Age group
<24	81	72	1
25–34	70	72	0.78 (0.46 1.31)	0.31
35–44	49	38	1.17 (0.62 2.18)	0.66
>45	40	34	1.05 (0.55 1.99)	0.89
Functional status
Working	34	28	1
Bedridden	206	188	0.69 (0.37 1.30)	0.25
Has treatment supporter
Yes	201	187	1
No	39	29	1.67 (0.91 3.05)	0.17
Complications
Yes	101	94	1
No	130	122	1.0 (0.65 1.54)	0.97
TB/HIV-co-infection
Yes	54	64	0.68 (0.41 1.13)	0.12
No	186	152	1
Cavitation
Yes	99	141	0.62 (0.39 0.96)*	0.028
No	91	125	1
GeneXpert MTB/RIF test
Yes	66	146	0.15 (0.10 0.24)*	<0.001
No	174	70	1
Form of TB
Pulmonary	288	193	1
Extrapulmonary	12	23	0.34 (0.14 0.81)*	0.018

Note: *Shows statistical significant at 0.05 P-value in the multivariable logistic regression model.

Table 4 Matching Estimates of GeneXpert MTB/RIF Test with Other Diagnostic Tests on Treatment Delay Among MDR-TB Patients (N = 456)

Variable	Sample	GeneXpert Test	Other Diagnostic Tests	Difference	Standard Error	T Statistics	P-value	95% CI
Treatment delay	Unmatched	0.31	0.71	−0.40	0.043	−9.34
	ATT	0.301	0.73	−0.43	0.046	−9.21	0.001	(−0.52 −0.30)
	ATU	0.70	0.30	−0.40
	ATE			−0.41

Table 5 Covariate Balance Check and Absolute Bias Reduction of Treatment Delay

Variable	Matching Status	Mean		% of Bias	% Bias Reduction	t-test (P-value)	V (T)/V (C)
		GeneXpert	Other Tests
TB/HIV Co-infection	Unmatched	0.283	0.23	10.3		1.10 (0.27)
	Matched	0.283	0.25	7.5	27.1	0.77 (0.44)
Age group	Unmatched	2.816	2.86	−3.6		−0.38 (0.70)	1.12
	Matched	2.816	2.63	12.5	−248.3	1.30 (0.19)	1.19
Functional status	Unmatched	1.839	1.88	−13.2		−1.42 (0.15)	1.33
	Matched	1.839	1.82	4.1	69	0.39 (0.69)	0.93
Cavitation	Unmatched	0.344	0.47	−27.7		−2.94 (0.003)
	Matched	0.344	0.32	3.9	86	0.41 (0.681)
Residence	Unmatched	1.533	1.51	4.1		0.44 (0.65)	1.00
	Matched	1.533	1.57	−8.5	−104.9	−0.88 (0.38)	1.02
Form of TB	Unmatched	1.099	1.05	15.5		1.67 (0.096)	1.65
	Matched	1.099	1.09	1.8	88.7	0.16 (0.87)	1.04
Treatment supporter	Unmatched	1.160	1.13	5.9		0.63 (0.53)
	Matched	1.160	1.11	13.2	−124.3	1.41 (0.15)
Complications	Unmatched	0.566	0.57	−2.4		−0.25 (0.79)	1.12
	Matched	0.566	0.62	12.4	−418.3	−1.29 (0.19)	1.34
Sex of patient	Unmatched	1.410	1.42	−2.4		0.25 (0.80)	0.99
	Matched	1.410	1.36	9.5	−301.3	1.00 (0.32)	1.05

Notes: Other tests (LPA: line probe assay, and culture and DST tests).