Unsuccessful Xpert<sup>®</sup> MTB/RIF results: the Nigerian experience

Gidado, Mustapha; Nwokoye, Nkiru N.; Nwadike, Peter; Ajiboye, P; Eneogu, Rupert; Useni, Sani; Onazi, J; Lawanson, Adebola; Elom, E; Tubi, A; Kuye, Joseph

doi:10.5588/pha.17.0080

Cited by 24 publications

(34 citation statements)

References 17 publications

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“…Poor performance in this testing procedure is mainly due to technical errors and non-adherence to standard operational procedure. 17 Disputed cases need repeat-testing and frequent transfer to referral laboratories for further tests and culture. There also remains a case for clinical suspicion of TB and therapeutic trial of anti TB drugs.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis of MDR Tuberculosis at a Tertiary Care Centre With Cbnaat Technology- A Two Year Study

Saha¹,

Saha²

2018

jebmh

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BACKGROUND Tuberculosis is a chronic multi system granulomatous disease with a predilection for the respiratory system. Traditional diagnostic protocols include history, chest x-ray and sputum collection and staining for acid fast bacilli along with culture in conventional media. These processes are time consuming and labour intensive. WHO recommends the use of Cartridge Based Nucleic Acid Amplification Testing (CBNAAT) using the Gene Xpert MTB/RIF apparatus which is a comparatively rapid PCR based test. MATERIALS AND METHODS In the present study, sputum and tissue samples from 1299 patients were taken and smear preparations were stained for acid fast bacilli. Subsequently, the samples were subjected to CBNAAT testing for both the presence of mycobacterium tuberculosis as well as rifampicin resistance, which is a marker for INH resistance as well. Rifampicin resistant tuberculosis is thus labelled as multi drug resistant tuberculosis (MDR TB). RESULTS In the results of the study, mycobacterium tuberculosis (MTB) was found in 1275 cases, Rifampicin sensitivity was found in 1095 cases, rifampicin resistance in 176 cases and indeterminate results in 4 cases. In 122 cases of the present study, CBNAAT has detected mycobacterium tuberculosis (MTB) where the cases were smear negative. On the other hand, 109 smear positive cases have been declared MTB negative by CBNAAT testing. 26 cases showed error, invalid test and no results. In 4 cases though MTB was detected, rifampicin resistance testing showed indeterminate results. CONCLUSION CBNAAT technology may be used as the standard diagnostic tool for tuberculosis. However for disputed cases, referral systems must be in place for mycobacterial culture and drug testing at reference laboratories.

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Section: Resultsmentioning

confidence: 99%

Diagnosis of MDR Tuberculosis at a Tertiary Care Centre With Cbnaat Technology- A Two Year Study

Saha¹,

Saha²

2018

jebmh

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“…It provides results fast (ideally within 2-4 h) compared to the 4-6 weeks of traditional bacteriological culture [1]. Despite the potential of Xpert® to improve case detection of TB, several studies, including those undertaken in Kenya, have shown that adoption and utilisation has been low [2][3][4][5]. Kenya introduced Xpert® in 2011 and now has over 156 machines, with more coming, including the newer improved Ultra® [6,7].…”

Section: Introductionmentioning

confidence: 99%

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

Oliwa

Odero

Nzinga

et al. 2020

BMC Health Serv Res

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Background: Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings. Methods: This was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes. Results: At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical).

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“…A qualitative study from Peru (a high TB burden, low-resource setting) also identi ed constraints to diagnosing TB in children related to ignorance and stigma; limited access to diagnostic tests; inadequately trained health centre staff; and provider shortages [13]. While several studies have highlighted the challenges of implementing Xpert® among adults, data addressing constraints to the use of this diagnostic among children are sparse [3,[14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

Oliwa¹,

Odero²,

Nzinga³

et al. 2020

Preprint

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Abstract Background Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings. Methods This was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes. Results At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical). Conclusion We used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries and can be feasibly implemented by the National TB programme.

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Unsuccessful Xpert^® MTB/RIF results: the Nigerian experience

Cited by 24 publications

References 17 publications

Diagnosis of MDR Tuberculosis at a Tertiary Care Centre With Cbnaat Technology- A Two Year Study

Diagnosis of MDR Tuberculosis at a Tertiary Care Centre With Cbnaat Technology- A Two Year Study

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

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Unsuccessful Xpert® MTB/RIF results: the Nigerian experience

Cited by 24 publications

References 17 publications

Diagnosis of MDR Tuberculosis at a Tertiary Care Centre With Cbnaat Technology- A Two Year Study

Diagnosis of MDR Tuberculosis at a Tertiary Care Centre With Cbnaat Technology- A Two Year Study

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting – modern diagnostics meet age-old challenges

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Unsuccessful Xpert^® MTB/RIF results: the Nigerian experience