The Role of GeneXpert® for Tuberculosis Diagnostics in Brazil: An Examination from a Historical and Epidemiological Perspective

Abstract

The rapid molecular test (RMT) performed on the GeneXpert® system is widely used as a control strategy and surveillance technique for tuberculosis (TB). In the region of the Americas, TB incidence is slowly increasing owing to an upward trend in Brazil, which is among the high TB-burden countries (HBCs), ranking in the 19th position. In this context, we aimed to (i) describe the implementation and history of RMT-TB (Xpert® MTB/RIF and Xpert® MTB/RIF Ultra) in Brazil; (ii) to evaluate the national RMT laboratory distribution, TB, and resistance to RIF detection by RMT; and (iii) to correlate these data with Brazilian TB incidence. The quantitative data of Xpert® MTB/RIF and Xpert® MTB/RIF Ultra assays performed in the pulmonary TB investigation from 2014 to 2020 were provided by the Brazilian Ministry of Health. A spatial visualization using ArcGIS software was performed. The Southeast region constituted about half of the RMT laboratories—from 39.4% to 45.9% of the total value over the five regions. Regarding the federal units, the São Paulo state alone represented from 20.2% to 34.1% (5.0 to 8.5 times the value) of RMT laboratories over the years observed. There were significant differences (p < 0.0001) in the frequency of RMT laboratories between all years of the historical series. There was an unequal distribution of RMT laboratories between Brazilian regions and federal units. This alerts us for the surveillance of rapid molecular detection of TB in different parts of the country, with the possibility of improving the distribution of tests in areas of higher incidence in order to achieve the level of disease control recommended by national and worldwide authorities.

Impact of Xpert MTB/RIF implementation in tuberculosis case detection and control in Brazil: a nationwide intervention time-series analysis (2011–2022)

“…Of note, similar improvements in TB case detection following Xpert's rollout were reported in specific regions of Brazil and other high TB burden countries. 3 , 24 , 25 Our study builds upon the previous works by extending the evaluation of Xpert's impact on TB and DR-TB detection rates at a nationwide level, while also incorporating a comprehensive assessment of temporal trends and the effectiveness of Xpert's adoption in various phases of its implementation. Additionally, our novel assessment captures both immediate impacts post Xpert's implementation and sustained benefits following the initial rollout.…”

Advancements in Tuberculosis Diagnostics: A Comprehensive Review of the Critical Role and Future Prospects of Xpert MTB/RIF Ultra Technology

“…Improving epidemiological and surveillance research: The extensive usage of Xpert MTB/RIF Ultra may help improve epidemiological and surveillance research [ 37 ]. The consistent and dependable outcomes of the system offer important information for tracking trends in tuberculosis, comprehending the occurrence of medication resistance, and guiding policy choices.…”