Evaluasi Keunggulan Tes Cepat Molekuler dengan Xpert MTB/ RIF Dibanding dengan Uji Mikroskopis dalam Mendiagnosis Tuberkulosis di Indonesia Tahun 2018

Abstract

Abstract
 Tuberculosis (TB) remains a severe health issue worldwide which is one of the death leading causes, particularly in developing countries including Indonesia. The purpose of this study is to evaluate the superiority of the molecular diagnostic test with Xpert MTB/RIF compared to the microscopic test in 44 health facilities in Indonesia in 2018. The results revealed that the Xpert MTB/RIF test could detect 31,9% positive TB from 33,630 suspected cases. The Xpert MTB/RIF were also able to detect 16.7% positive samples from 5.491 samples which were previously negative tested by microscopic technique. The positive TB was dominated by the male in the age group of 15 to 54 years. Moreover, Xpert MTB/RIF test could examine the not-sputum samples of 0.16% (52 of 33,630 samples), which 9 samples of them were positive TB (17.3%). These positive TB samples were derived from gastric fluid (77.8%), pleural fluid (11.1%), and lymph node aspiration (11.1%), which majority were from children under 15 years old. This study concluded that the superiority of TCM test included its sensitivity to detect positive TB in resistant rifampicin cases, to identify the existence of MTB resistant to rifampicin drugs simultaneously and to detect the MTB with the non-sputum samples.
 Keywords: evaluation, TB, Xpert MTB/RIF test
 Abstrak
 Tuberkulosis (TB) masih merupakan masalah kesehatan global yang serius dan penyebab utama kematian di seluruh dunia terutama di negara berkembang termasuk Indonesia. Tujuan dari penelitian ini adalah mengevaluasi keunggulan pemeriksaan diagnostik Tes Cepat Molekuler (TCM) Xpert MTB/RIF dibanding dengan pemeriksaan mikroskopis di 44 fasilitas kesehatan di Indonesia tahun 2018. Hasil pemeriksaan TCM dengan Xpert MTB/RIF dari 33.630 terduga TB terdapat TB positif sebesar 31,9%. Pemeriksaan mikroskopis dengan hasil negatif sebanyak 5.491 terduga TB yang juga diperiksa TCM dengan Xpert MTB/RIF terdapat hasil TB positif sebesar 16,7%. Hasil TB positif tersebut didominasi kelompok umur 15-54 tahun dan laki-laki. Pemeriksaan TCM ini juga mampu memeriksa spesimen bukan sputum sebesar 0,16% dan hasilnya 9 di antaranya adalah TB positif (17,3%). Spesimen TB positif ini berasal dari bilasan/ aspirasi cairan lambung 77,8% (7 dari 9 spesimen), cairan pleura 11,1% (1 dari 9 spesimen) dan aspirasi limfonodus 11,1% (1 dari 9 spesimen). Dilihat dari kelompok umur lebih dari separuh spesimen bukan sputum ini berasal dari anak <15 tahun. Penelitian ini menyimpulkan bahwa TCM dengan Xpert MTB/RIF lebih unggul daripada pemeriksaan mikroskopis karena sensitivitasnya pada rifampisin sensitif maupun resisten, mampu mengidentifikasi keberadaan MTB yang resisten obat rifampisin secara bersamaan serta sampel bukan-sputum.
 Kata kunci: Evaluasi, TB, Tes Cepat Molekuler dengan Xpert MTB/RIF

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