Scaling Up Molecular Diagnostic Tests for Drug-Resistant Tuberculosis in Uzbekistan from 2012–2019: Are We on the Right Track?

Abstract

Uzbekistan has a large burden of drug-resistant tuberculosis (TB). To deal with this public health threat, the National TB Program introduced rapid molecular diagnostic tests such as Xpert MTB/RIF (Xpert) and line probe assays (LPAs) for first-line and second-line drugs. We documented the scale-up of Xpert and LPAs from 2012–2019 and assessed whether this led to an increase in patients with laboratory-confirmed multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) and extensively drug-resistant TB (XDR-TB). This was a descriptive study using secondary program data. The numbers of GeneXpert instruments cumulatively increased from six to sixty-seven, resulting in annual assays increasing from 5574 to 107,330. A broader use of the technology resulted in a lower proportion of tests detecting Mycobacterium tuberculosis with half of the positive results showing rifampicin resistance. LPA instruments cumulatively increased from two to thirteen; the annual first-line assays for MDR-TB increased from 2582 to 6607 while second-line assays increased from 1435 in 2016 to 6815 in 2019 with about one quarter to one third of diagnosed patients showing second-line drug resistance. Patient numbers with laboratory-confirmed MDR-TB remained stable (from 1728 to 2060) but there was a large increase in patients with laboratory-confirmed XDR-TB (from 31 to 696). Programmatic implications and ways forward are discussed.

Prevalence of chronic pulmonary aspergillosis and the antifungal drug resistance of Aspergillusspp. in pulmonary tuberculosis patients in Uzbekistan

“…Uzbekistan has seen a significant decline in the number of reported cases of PTB over the last 16 years (94/100K in 2003 to 49/100K in 2019). 23,24 Despite this progress, the country is still amongst the 30 countries in the world with the highest multidrug resistant tuberculosis burden. 25 Furthermore, the situation is complicated by undiagnosed fungal infections among groups at risk as well as limited fungal diagnosis resources in Uzbekistan.…”

Factors Associated with Unfavourable Treatment Outcomes in Patients with Tuberculosis: A 16-Year Cohort Study (2005–2020), Republic of Karakalpakstan, Uzbekistan

“…In terms of trends in favourable outcomes, it was encouraging to see an increase in the proportion of patients cured, especially in the last five years. The reasons for this probably include (a) a countrywide scaling up of universal access to rapid molecular diagnostic tests, and (b) increasing treatment compliance with national treatment guidelines [ 11 , 14 ].…”

“…People with presumptive TB are usually screened at the primary health care level and sputum specimens are sent to district TB laboratories for sputum smear microscopy. However, starting from 2016, Xpert MTB/RIF (a molecular diagnostic assay) has become the first test of choice in all regions of Uzbekistan [ 11 ]. In addition, it is now recommended that patients are considered for chest radiography and mycobacterial culture as part of the diagnostic work-up [ 12 ].…”

Acupuncture as adjunctive treatment for linezolid-induced peripheral neuropathy: a case series report

“…Pulmonary tuberculosis (PTB), which mainly affects adults and children, serves as a major source of transmission of the infection. Therefore, accurate diagnosis and timely, effective treatment are critical to any successful TB control strategy (3).…”