Xpert MTB/RIF assay for the diagnosis of Mycobacterium tuberculosis and Rifampicin resistance in high Human Immunodeficiency Virus setting in Gambella regional state, southwest Ethiopia

Abstract

BackgroundThe introduction of a new and rapid molecular diagnostic for tuberculosis (TB) and rifampicin resistance (RIF) in the national TB program has improved the diagnosis of TB by shortening the turnaround time and detecting the presence of RIF resistance in high TB and human immunodeficiency virus (HIV) settings such as Ethiopia. However, the implementation of this new diagnostic tool for the diagnosis of M. tuberculosis (MTB) and rifampicin (RIF) resistance in clinical setting is limited known in the country. Hence, this study intended to describe the program of GeneXpert MTB/RIF in the diagnosis of TB and RIF in high HIV setting in Gambella Regional State, Southwest Ethiopia.MethodInstitutional based retrospective study was conducted among presumptive TB patients diagnosed with GeneXpert assay in the last three years (2015–2017) in Gambella Hospital from May 1–30, 2017. The data were collected from GeneXpert registration book using standard data extraction sheet. The data were entered and cleared using EPI data 3.1 and then, exported and analyzed using SPSS version 20.0 statistical software package.ResultOf the 995 presumptive TB patients who received the GeneXpert test in the last three years, 20.0% (95% CI: 17.4–22.7) of them had proven MTB detection while 4.9% (95% CI: 2.2–8.1) had RIF resistance. The prevalence of RIF resistance was 2.3% and 14.3% among the new and retreated cases respectively. There was also a 35.5% TB/HIV co-infections. The odd of MTB detection was higher among 15–29 [AOR 2.17 (95% CI: 1.25- 3.76)] and 30–44 [AOR 2.35 (95% CI: 1.36–4.07)] year old participants. The figure was however significantly lower among female [AOR 0.64 (95% CI: 0.45–0.91)] and unknown HIV status [AOR 0.38(95% CI: 0.24–0.61)] participants of the study. In addition, the odd of RIF resistance was significantly low among HIV unknown case [AOR 0.14 (95% CI: 0.02–0.96)]. It was also learnt that there was progressively decline of invalid or error Xpert result from 4.7% to 2.0% in the course of the study period (X2, 25.54; P = 0.001).ConclusionThe study confirms the high prevalence of TB, RIF resistance and TB/HIV co-infection among the study participants. Age, sex, and HIV status of the study participants were predictor factors for MTB detection while HIV status was associated with RIF resistance. Therefore, the results of the study indicate that there is the need for collaborative and intensified prevention of TB and HIV in the study area. The ongoing supervision and mentoring to improve the performance of Xpert in the institution need to be promoted.

Does Xpert® MTB/RIF assay give rifampicin resistance results without identified mutation? Review of cases from Addis Ababa, Ethiopia

“…In a systematic review conducted in Ethiopia, it was also reported that being male has been identified as a risk factor for multi-drug resistant tuberculosis [9]. The most highly affected age groups were productive individuals found in the age group of 25-34 years, which is comparable with various studies [1,[10][11][12]. This might be due to exposure to open cases of TB where young individuals especially males are prone to TB associated risk factors.…”

Trends of Mycobacterium Tuberculosis and rifampicin resistance in Adigrat General Hospital, Eastern Zone of Tigrai, North Ethiopia

“…In the present study, the overall forms of presumptive Mycobacterium tuberculosis positivity rate were 24.3%. Our nding was similar to studies conducted in the Debre Markos Hospital (23.2%) [13], Gondar Referral Hospital (24.6%) [14], Gambella (20.0%) [46], Afar (24.5%) [49], India (27.6%) [4], South Africa (26%) [15], Nigeria (22.9 %) [16] And the WHO report in Africa (25%) [2]. However, it was lower compared to reports in Jigjiga (65.5%) [17], Kenya (32.25%) [18], in eastern Uttar Pradesh (32.9%) [19] and Congo (79.1%) [47].The main difference in these latter ndings may show our inclusion of all forms of presumptive tuberculosis while other studies included identi ed cases of Mycobacterium tuberculosis.…”

“…The co-infection of TB-HIV in this study was found to be high at 33.3% (171/513). This nding was supported by previous studies conducted in Amhara (27.7%) [26], Gambella [46], in Ethiopia (29.4%) [27], and in Central Nigeria (36.3%) [28]. However, our ndings were higher than studies conducted in the Debre Markos Referral Hospital (16.6%) [13], different studies across Ethiopia (20.3-24.2 %) [14,[29][30][31][32], and a WHO estimation for Ethiopia of 14% (9.6%-19%) [2].…”

“…In the present study, the percentage of Mycobacterium tuberculosis positivity signi cantly higher in presumptive TB patients (20.0 %) compared to presumptive drug resistance (4.3 %) with (P < 0.00). This nding was comparable to studies conducted in Afar (20.9) [49], Debre Markos Referral Hospital (15.1%) [13] and Gambella (19.6%) [46]. However, it is much lower than studies conducted in Felege Hiwot Referral Hospital and Debre Tabor Hospital (54.8) [20], Gondar (25.2 %) [14] and Zimbabwe (37.1%) [37].The discrepancies might be due to our inclusion of all presumptive TB cases, and a high number of participants.…”

Does Xpert MTB/RIF Assay Give Rifampicin Resistance Results Without Identified Mutation? Review of Cases from Addis Ababa, Ethiopia.

“…In a systematic review conducted in Ethiopia, it was also reported that being male has been identified as a risk factor for multi-drug resistant tuberculosis (9). The most highly affected age groups were productive individuals found in the age group of 25-34 years, which is comparable with various studies (1,(10)(11)(12). This might be due to exposure to open cases of TB where young individuals especially males are prone to TB associated risk factors.…”