Drug-resistant tuberculosis diagnosis since Xpert^® MTB/RIF introduction in Papua New Guinea, 2012–2017

Abstract

Xpert ® MTB/RIF was introduced in Papua New Guinea in 2012 for the diagnosis of tuberculosis (TB) and of rifampicin-resistant TB (RR-TB), a marker of multidrug-resistant TB (MDR-TB). Objective: To assess the concordance of Xpert with phenotypic drug susceptibility testing (DST) performed at the supranational reference laboratory and to describe the patterns of drug-resistant TB observed. Design: This was a retrospective descriptive study of laboratory data collected from April 2012 to December 2017. Results: In 69 months, 1408 specimens with Xpert results were sent for mycobacterial culture and DST; Mycobacterium tuberculosis was cultured from 63% (884/1408) and DST was completed in 99.4%. The concordance between Xpert and culture for M. tuberculosis detection was 98.6%. Of 760 RR-TB cases, 98.7% were detected using Xpert; 98.5% of 620 MDR-TB cases were identified using phenotypic DST. Phenotypic resistance to second-line drugs was detected in 59.4% (522/879) of specimens tested, including 29 with fluoroquinolone resistance; the majority were from the National Capital District and Daru Island. Conclusion:The high concordance between phenotypic DST and Xpert in identifying RR-TB cases supports the scale-up of initial Xpert testing in settings with high rates of drug resistance. However, rapid DST in addition to the detection of RR-TB is required.

Implementation of GeneXpert for TB Testing in Low- and Middle-Income Countries: A Systematic Review

“…1,3 In addition, approximately half a million cases of rifampicin-resistant TB were diagnosed in 2019. 1,4 Of these cases, 78% had multidrug-resistant TB (MDR-TB). 1 It has also been estimated that up to one-third of global TB cases and more than threequarters of MDR-TB cases are undetected, 3 equating to upward of 3.3 million people globally living with active TB who are unaware of their status and remain undiagnosed.…”

Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015–2017

“…Although condoms are available, their use is limited by gender disparities, stigma, and financial barriers ( 23 ). Improved access to affordable, accurate point-of-care diagnostics would lead to more accessible and appropriate treatment, resulting in improved sexual and reproductive health; the widespread implementation of GeneXpert for tuberculosis diagnosis ( 44 ) might also increase access to STI diagnosis in Papua New Guinea.…”

Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries

“…Major challenges exist for bacteriological confirmation, and a lack of diagnostic skills in some health workers results in both overdiagnosis and underdiagnosis. Xpert is increasingly available in PNG but is still limited to the major provincial centers [64]. Currently, more than 95% of child TB is clinically diagnosed, and, even if respiratory specimens are available, the yield of Xpert for PTB is low.…”