The Role of GeneXpert MTB/RIF in Reducing Treatment Delay Among Multidrug Resistance Tuberculosis Patients: A Propensity Score Matched Analysis

Abstract

Background GeneXpert MTB/RIF testing is a rapid molecular diagnostic test that is performed with an automated cartilage-based machine that makes treatment initiation prompt. This study aimed at evaluating the impact of GeneXpert in the reduction of treatment delay among multidrug-resistant tuberculosis (MDR-TB) patients in Amhara regional state of Ethiopia. Methods A facility-based retrospective follow-up study was conducted from January to February 2019, and a total of 465 MDR-TB patients were included in the study. Socio-demographic, clinical, and treatment-related characteristics were collected from patient’s chart retrospectively using data abstraction sheets. Binary logistic regression model was fitted to identify factors associated with treatment delay; adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. A propensity score-matched (PSM) analysis was used to assess the impact of the GeneXpert MTB/RIF test on treatment delay through calculation of average treatment effect (ATE). Results The majority, 92.4%, of patients had the pulmonary form of TB, and 46.7% of patients were diagnosed by GeneXpert MTB/RIF. The presence of cavitation (AOR = 0.62, 95% CI: 0.39 0.96), extrapulmonary form of TB (AOR = 0.34, 95% CI: 0.14 0.81), and GeneXpert (AOR = 0.15, 95% CI: 0.10 0.24) were factors associated with treatment delay. The average treatment effect (ATE) of PSM analysis showed that GeneXpert MTB/RIF has significantly reduced treatment delay by 41% compared to matched control groups. Conclusion This study revealed that GeneXpert test has a strong association with the reduced treatment delays among MDR-TB patients. This underscores that rapid molecular tests could help improve the health system and lead to prompt initiation of MDR-TB treatment. Therefore, expansion and decentralization of GeneXpert tests to peripheral health facilities are highly recommended. In turn, the case detection and control of the disease will be hastened.

Diagnostic biomarkers for active tuberculosis: progress and challenges

“…Finally, the technology remains expensive and requires a constant source of electricity, limiting its use in highly endemic resource‐limited settings (Nalugwa et al , 2020 ). GeneXpert MTB/RIF has represented an important advance in TB diagnosis facilitating earlier diagnosis and treatment where it is available (Ershova et al , 2020 ; Tamirat et al , 2022 ). It has, however, not been able to increase TB detection worldwide as initially expected, in part due to continued treatment of suspected TB based on clinical criteria rather than a diagnostic test (Walzl et al , 2018 ).…”

Access the Diagnostic Accuracy of GeneXpert to Detect <em>Mycobacterium tuberculosis</em> and Rifampicin-Resistance Tuberculosis among Presumptive Tuberculosis and Presumptive Drug Resistant Tuberculosis Patients

“…The Xpert MTB/RIF testing is a rapid molecular diagnostic test performed with an automated cartilage-based Xpert machine (Cepheid, USA). The Xpert tool enables healthcare professionals to improve the speed and quality of TB diagnosis and helps diagnose TB in patients likely to be missed by traditional screening tests [5]. The fact that it allows diagnosis of TB simultaneously as pinpointing resistance to rifampicin treatment is vital in minimizing the transmission of drug-resistant TB in TB-endemic countries.…”

Assess the Diagnostic Accuracy of GeneXpert to Detect Mycobacterium tuberculosis and Rifampicin-Resistant Tuberculosis among Presumptive Tuberculosis and Presumptive Drug Resistant Tuberculosis Patients

“…The GeneXpert MTB/RIF testing is a rapid molecular diagnostic test performed with an automated cartilage-based GeneXpert machine (Cepheid, Sunnyvale, CA, USA). The GeneXpert tool enables healthcare professionals to improve the speed and quality of TB diagnosis and helps diagnose TB in patients likely to be missed by traditional screening tests [8]. The fact that it allows diagnosis of TB simultaneously as pinpointing resistance to rifampicin treatment is vital in minimizing the transmission of drug-resistant TB in TB-endemic countries.…”