Implementation Research to Inform the Use of Xpert MTB/RIF in Primary Health Care Facilities in High TB and HIV Settings in Resource Constrained Settings

Muyoyeta, Monde; Moyo, Maureen; Kasese, Nkatya; Ndhlovu, Mapopa; Milimo, Deborah; Mwanza, Winfridah; Kapata, Nathan; Schaap, Albertus; Faussett, Peter Godfrey; Ayles, Helen

doi:10.1371/journal.pone.0126376

Cited by 17 publications

(22 citation statements)

References 25 publications

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“…Our finding was comparable with previous reports from similar findings reported in Ethiopia and elsewhere in the world (19.4-45.3%). [14][15][16] But it was higher than similar findings reported in Southern, Northern Eastern, and Northwest part of Ethiopia with the prevalence of 3.4%, 2.5%, and 1.7%, and 9.3 [17][18][19][20] respectively. This difference might be attributed to unorganized patient diagnosis, treatment, and follow-up that may contribute to the higher prevalence of rifampicin resistance in the study area.…”

Section: Discussionmentioning

confidence: 71%

<p>Rifampicin-Resistant Multidrug-Resistant Tuberculosis Cases in Selected Hospitals in Western Oromia, Ethiopia: Cross-Sectional Retrospective Study</p>

Zewdie

Dabsu

Tola

et al. 2020

IDR

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Purpose: With the recommendation of World Health Organization (WHO) and as per the Ethiopian National Implementation Guideline, GeneXpert is used for rapid diagnosis of rifampicin (RIF)-resistant multidrug-resistant tuberculosis (MDR-TB) from the suspected TB patients; however, there were limited findings in Ethiopia particularly in the study area showing the magnitude of RIF-resistant MDR-TB and related factors among suspected TB cases. Hence, we aimed to assess resistance to RIF as a biomarker for the detection of MDR-TB cases from the suspected TB patients in selected hospitals, Western Oromia, Ethiopia. Patients and Methods: We have conducted a cross-sectional review on 2300 registered GeneXpert data as clinically suspected TB cases in three governmental hospitals, Western Oromia, Ethiopia, between October 2015 and April 2016 to assess resistance to RIF as a biomarker for the detection of MDR-TB cases. Trained data collectors enumerated the data using pre-tested semi-structured questionnaires from the Gene Xpert records found in the registration logbook available at each hospital laboratories. Following checking the data for completeness, we have cleaned and entered our data into SPSS version 20 to compute different analyses. P-value of ≤0.05 was taken as statistically significant. Results: A total of 2300 TB suspected cases were included in the study. The overall prevalence of TB diagnosed by the GeneXpert assay was 21.3% (491/2300). In all TB confirmed cases, RIF-resistant TB accounted for 25.9% (127/491) which expressed rpoB gene mutations. Sex (being male), age (within 16-30 age group), patient category (relapse, loss to follow-up, treatment failure and had MDR-TB contact) were significantly associated with rifampicin-resistant TB. Relapse patient was 20 times more likely to develop MDR-TB when compared to the new patient (P-value= 0.01, COR = 20.0, 95%C.I = 17.5-42.5). Conclusion: The rifampicin-resistant TB is prevalent in all age groups. The strong association and high prevalence of RIF-resistant TB to failure after treatment in this study require more attention towards improving the treatment to minimize evolving of the MDR-TB cases.

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Section: Discussionmentioning

confidence: 71%

<p>Rifampicin-Resistant Multidrug-Resistant Tuberculosis Cases in Selected Hospitals in Western Oromia, Ethiopia: Cross-Sectional Retrospective Study</p>

Zewdie

Dabsu

Tola

et al. 2020

IDR

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“…De acordo com Muyoyeta et al 45 , a recomendação da OMS para o uso do GeneXpert para pacientes HIV positivos suscita problemas éticos e de recursos. Pacientes com baciloscopia negativa que não têm HIV associado devem também ser considerados para teste com o GeneXpert, o que pode evitar atrasos no diagnóstico e a contínua transmissão da doença a partir desses doentes.…”

Section: Discussionunclassified

“…Muitos estudos relataram a rapidez e simplicidade do método 37,39,46,47,48 , o início do tratamento precoce 45,49,50,51 , a diminuição do número de contaminações cruzadas 52 , o aumento do número de casos positivos não detectados por baciloscopia ou cultura 18,37 e se tratar de um método sensível e específico 53,54 . Além disso, ao contrário da baciloscopia, as etapas de pipetagem manual e a parte automatizada do ensaio não geram aerossóis viáveis, resultando em riscos biológicos mínimos 20,22 ; e o desempenho do teste pode ser menos dependente da habilidade do usuário, motivação ou carga de trabalho da baciloscopia 11 .…”

Section: Discussionunclassified

Teste rápido molecular GeneXpert MTB/RIF para diagnóstico da tuberculose

Maschio-Lima

Belotti

Nardi

et al. 2017

Revista Pan-Amazônica de Saúde

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RESUMOINTRODUÇÃO: Em 2013, no Sistema Único de Saúde, foi implantada uma ferramenta rápida para o diagnóstico da tuberculose (TB), o método GeneXpert MTB/RIF, que detecta a presença do material genético do complexo Mycobacterium tuberculosis e a resistência à rifampicina em uma única reação, fornecendo resultados dentro de 2 h. OBJETIVO: Analisar os resultados da utilização do método GeneXpert para o diagnóstico laboratorial da TB. METODOLOGIA: Realizou-se uma revisão de literatura sobre o método GeneXpert, com a utilização de manuais e artigos, em diferentes idiomas, das fontes MEDLINE, SciELO, LILACS e Google Acadêmico, na qual foram selecionados 60 artigos. RESULTADOS: Dos 49 artigos que relataram o uso de material clínico, 51,0% (N = 25) analisaram amostras provenientes de países considerados prioritários pela Organização Mundial da Saúde. Embora 63,2% (N = 31) dos artigos se reportem a amostras pulmonares, alguns estudos mostraram boa performance do método em amostras extrapulmonares. A sensibilidade do GeneXpert nos estudos analisados variou entre 46,0% e 100,0%. As pesquisas revelaram bom desempenho do método molecular GeneXpert para o diagnóstico da TB. A técnica é considerada simples, com baixos riscos biológicos, com custo equivalente ao de outras técnicas moleculares, e pode ser realizada com treinamento mínimo. CONCLUSÃO: Muitos estudos apontaram a rapidez, a boa sensibilidade e a especificidade desse método. O GeneXpert ainda não elimina a necessidade do uso de métodos bacteriológicos tradicionais. Trabalhos futuros poderão esclarecer algumas divergências entre as pesquisas consultadas, principalmente em relação à resistência à rifampicina.

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“…Procedures for Xpert testing and smear microscopy have been described elsewhere and followed standard operating procedures [18, 19]. …”

Section: Methodsmentioning

confidence: 99%

Digital CXR with computer aided diagnosis versus symptom screen to define presumptive tuberculosis among household contacts and impact on tuberculosis diagnosis

et al. 2017

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BackgroundHousehold (HH) contact tracing is a strategy that targets high risk groups for TB. Symptom based screening is the standard used to identify HH contacts at risk for TB during HH contact tracing for TB. However, this strategy may be limited due to poor performance in predicting TB. The objective of this study was to compare CXR with Computer Aided Diagnosis (CAD) against symptom screen for defining presumptive TB and how TB detection changes with each method.MethodsHousehold contacts of consecutive index bacteriologically confirmed TB cases were visited by study teams and given TB/HIV education to raise awareness of the risk of TB following close contact with a TB patient. Contacts were encouraged to visit the health facility for screening; where symptoms history was obtained and opt out HIV testing was provided as part of the screening process. CXR was offered to all regardless of symptoms, followed by definitive sputum test with either Xpert MTB RIF or smear microscopy.ResultsAmong 919 HH contacts that presented for screening, 865 were screened with CXR and 464 (53.6%) had an abnormal CXR and the rest had a normal CXR. Among 444 HH contacts with valid sputum results, 274 (61.7%) were symptom screen positive and 255 (57.4%) had an abnormal CXR. Overall, TB was diagnosed in 32/444 (7.2%); 13 bacteriologically unconfirmed and 19 bacteriologically confirmed. Of 19 bacteriologically confirmed TB 8 (42.1%) were symptom screen negative contacts with an abnormal CXR and these 6/8 (75.0%) were HIV positive. Among the 13 bacteriologically unconfirmed TB cases, 7 (53.8%) were HIV positive and all had an abnormal CXR.ConclusionSymptom screen if used alone with follow on definitive TB testing only for symptom screen positive individuals would have missed eight of the 19 confirmed TB cases detected in this study. There is need to consider use of other screening strategies apart from symptom screen alone for optimal rule out of TB especially in HIV positive individuals that are at greatest risk of TB and present atypically.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2388-7) contains supplementary material, which is available to authorized users.

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Implementation Research to Inform the Use of Xpert MTB/RIF in Primary Health Care Facilities in High TB and HIV Settings in Resource Constrained Settings

Cited by 17 publications

References 25 publications

<p>Rifampicin-Resistant Multidrug-Resistant Tuberculosis Cases in Selected Hospitals in Western Oromia, Ethiopia: Cross-Sectional Retrospective Study</p>

<p>Rifampicin-Resistant Multidrug-Resistant Tuberculosis Cases in Selected Hospitals in Western Oromia, Ethiopia: Cross-Sectional Retrospective Study</p>

Teste rápido molecular GeneXpert MTB/RIF para diagnóstico da tuberculose

Digital CXR with computer aided diagnosis versus symptom screen to define presumptive tuberculosis among household contacts and impact on tuberculosis diagnosis

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