Scaling Up Molecular Diagnostic Tests for Drug-Resistant Tuberculosis in Uzbekistan from 2012-2019: Are We on the Right Track?

Sharofiddin Yuldashev,Oleksandr Korotych,Laziz Turaev,Anthony Harries,Nargiza Parpieva,Kostyantyn Dumchev,Salikhdjan Alimov,Khasan Safaev,Jamshid Gadoev

doi:10.3390/ijerph18094685

Abstract

Uzbekistan has a large burden of drug-resistant tuberculosis (TB). To deal with this public health threat, the National TB Program introduced rapid molecular diagnostic tests such as Xpert MTB/RIF (Xpert) and line probe assays (LPAs) for first-line and second-line drugs. We documented the scale-up of Xpert and LPAs from 2012–2019 and assessed whether this led to an increase in patients with laboratory-confirmed multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) and extensively drug-resistant TB (XDR-TB). This was a descriptive study using secondary program data. The numbers of GeneXpert instruments cumulatively increased from six to sixty-seven, resulting in annual assays increasing from 5574 to 107,330. A broader use of the technology resulted in a lower proportion of tests detecting Mycobacterium tuberculosis with half of the positive results showing rifampicin resistance. LPA instruments cumulatively increased from two to thirteen; the annual first-line assays for MDR-TB increased from 2582 to 6607 while second-line assays increased from 1435 in 2016 to 6815 in 2019 with about one quarter to one third of diagnosed patients showing second-line drug resistance. Patient numbers with laboratory-confirmed MDR-TB remained stable (from 1728 to 2060) but there was a large increase in patients with laboratory-confirmed XDR-TB (from 31 to 696). Programmatic implications and ways forward are discussed.

Highlights

Introduction is properly citedIn any reproductionDespite being an ancient disease, tuberculosis (TB) remains a huge global public health threat
This is the first study from Uzbekistan documenting the national scale-up, use and results of molecular diagnostic tests between 2012 and 2019 along with numbers confirmed in the laboratory and numbers enrolled on treatment
GeneXpert instruments were deployed in HIV care facilities to support the screening and detection of TB amongst people living with HIV who are at the highest risk of TB [20] and in the penitentiary sector where there is a high burden of TB

Summary

Introduction

Despite being an ancient disease, tuberculosis (TB) remains a huge global public health threat. Pulmonary tuberculosis (PTB) accounts for the majority of TB disease in adults and children and is the principal source of ongoing transmission of the infection. Sputum smear microscopy has been the global mainstay of PTB diagnosis for over years due to its availability and simplicity. It has several shortcomings of this article there should not be any suggestion that WHO or this article endorse any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL

Methods

Results

Discussion

Conclusion