Use of Xpert MTB/RIF for the Identification of TB and Drug Resistance Among Smear-Negative and Re-Treatment Cases in Rural Areas of Ethiopia

Mesfin Worku,Sally Theobald,Mubarek A Yassin,Mohammed A Yassin,Daniel G Datiko,Mulualem Agonafir,Luis E Cuevas

doi:10.2174/1874285801913010188

Mesfin Worku, Sally Theobald + Show 5 more

Open Access

https://doi.org/10.2174/1874285801913010188

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Abstract

Introduction: Tuberculosis (TB) remains a leading infectious cause of morbidity and mortality worldwide. A key contributor to this burden is poor diagnosis as only 60% of new pulmonary tuberculosis (TB) cases in Africa are ever detected. Therefore, this study aimed to assess the feasibility of Xpert MTB/RIF test implementation in the region, and the performance of the assay to increase case detection on the selected rural health care setting. Objective: To assess the feasibility of Xpert MTB/RIF test implementation in the rural health care setting in Southern Ethiopia. Methods: Two Xpert MTB/RIF machines were brought in 2012 through TB REACH project. It was placed at Yirgalem hospital and at Aletawondo health centre. The instruments were installed after formal training was provided to laboratory technologists for three days. We collected sputum sample from participants who repeatedly had negative smear microscopy and those who had not responded to first-line anti-TB drugs. Result: Of the total participants tested, 1828 have valid result (MTB-, MTB+/RIF-, MTB+/RIF+, MTB+/RIF Indeterminate). From the participants with valid results, 217 (11.9%) were Xpert-positive of which were 165 (9.0%) RIF-negative, 6 (0.3%) RIF-indeterminate and 46 (2.5%) RIF-positive. Among TB suspects with previous treatment history and positive by Xpert, RIF resistance was detected in 10 (2.2%). From the new TB suspects with positive Xpert, RIF resistance was detected in 29 (2.7%). All cases identified were linked with TB/MDR-TB treatment centers. Conclusion: Xpert provides an additional tool for the diagnosis of TB and drug resistance, with almost 12% of new and retreatment cases obtaining information that is useful for clinical management. To enhance its efficient utilisation, operational challenges should be minimized particularly in relation to availing robust alternative power source.

Highlights

Tuberculosis (TB) remains a leading infectious cause of morbidity and mortality worldwide
Xpert provides an additional tool for the diagnosis of TB and drug resistance, with almost 12% of new and retreatment cases obtaining information that is useful for clinical management
In 2010, WHO endorsed a rapid, automated, cartridge-based nucleic acid amplification test (NAAT), the Xpert MTB/RIF assay (Cepheid, Sunnyvale, USA), that simultaneously detects the presence of TB and genetic markers of rifampicin (RIF) resistance.The assay has high sensitivity (89%) and specificity (99%) for pulmonary TB detection [7]

Summary

Introduction

Tuberculosis (TB) remains a leading infectious cause of morbidity and mortality worldwide. A key contributor to this burden is poor diagnosis as only 60% of new pulmonary tuberculosis (TB) cases in Africa are ever detected. A key contributor to this burden of morbidity and mortality is poor diagnosis as only 60% of new pulmonary tuberculosis (TB) cases in Africa are ever detected [2]. The Ethiopian TB control program uses a passive strategy to identify cases of TB and patients are mostly identified when they attend curative and diagnostic services To complement this approach, we have implemented a community-based approach in which health extension workers (HEWs) conduct house to house visits to identify individuals with chronic cough or, collect sputum for examination, which is collected by supervisors and examined at the nearby designated microscopy centre, as described in Yasin et al 2013 [8].

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