Xpert® MTB/RIF for national tuberculosis programmes in low-income countries: When, where and how?

Arnaud Trébucq, D. A. Enarson, C. Y. Chiang, A. Van Deun, A. D. Harries, F. Boillot, A. Detjen, P. I. Fujiwara, S. M. Graham, I. Monedero, I. D. Rusen, H. L. Rieder

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103 引文 斯高帕斯(Scopus)

摘要

Xpert® MTB/RIF offers new and important possibilities for the diagnosis of sputum smear-negative tuberculosis (TB) and/or rifampicin (RMP) resistance, and many are encouraging rapid and widespread implementation. This simple test can be implemented almost everywhere, and it provides results within a few hours. In low-income countries (LICs), however, its cost, environmental limitations (stable and regular electricity, adequate room temperature) and difficulties involved in supply and maintenance are major obstacles. While it may be suitable for major reference hospitals, operational research is needed to evaluate the test and its additional yield above high-quality smear microscopy and clinical algorithms before its use at the peripheral level. In the meantime, direct microscopy should remain the initial diagnostic test for TB suspects. In most LICs, the prevalence of RMP resistance among new TB patients is very low; an Xpert MTB/RIF result indicating RMP resistance will thus always need confirmation by another test. In a population at high risk of RMP resistance (>15%), however, the positive predictive value for RMP resistance by Xpert MTB/RIF is high, and identification of RMP resistance is an excellent proxy for multidrug-resistant TB (MDR-TB). The assay should be widely used for this purpose if, and only if, excellent MDR-TB management is available, both for ethical reasons and to reduce the risk of extensively drug-resistant TB.

原文英語
頁(從 - 到)1567-1571
頁數5
期刊International Journal of Tuberculosis and Lung Disease
15
發行號12
DOIs
出版狀態已發佈 - 十二月 2011
對外發佈Yes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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