A suggested algorithm for detection of multi drug-resistant tuberculosis in Zimbabwe MDR-TB detection in resource limited settings

• Published in: Journal of infection in developing countries 2017-08, Vol.11 (8), p.611
• Main Authors: Makamure, Beauty, Makumbirofa, Salome, Bandason, Tsitsi, Leccese, Paul, Mutetwa, Reggie, Robertson, Val, Mason, Peter
• Format: Article
• Language: English
• Subjects: Drug resistance; Medical diagnosis; Tuberculosis
• ISSN: 2036-6590; 1972-2680
• DOI: 10.3855/jidc.8009

Introduction: Rapid genotypic and phenotypic methods for multi-drug-resistant-tuberculosis (MDR-TB) detection are now widely available. Zimbabwe adopted the use of GeneXpert-MTB/RIF, microscopic-observation-drug-susceptibility-assay (MODS) and Mycobacteria-Growth-Indicator-Tube (MGIT) drug-susceptibility-testing (DST). Data is limited on the ideal combination of use of these methods in resource limited settings. Methodology: Between August 2014 to July 2015, 211 sputa from MDR-TB suspects were tested with GeneXpert-MTB/RIF, MODS, manual-MGIT and Lowenstein-Jensen (LJ)-DST to determine diagnostic accuracy and turnaround-time (TAT), with LJ-DST as the gold standard. A performance score ranking table for diagnostic accuracy, TAT, costs, facilities and expertise requirements, was used to determine the most favourable tool. Results: GeneXpert-MTB/RIF sensitivity was 96% (95%CI:80-100) and specificity was 95% (95%CI:90-97). MODS sensitivity was 88% (95%CI:68-97) and specificity was 97% (95%CI:87-100). Manual MGIT-DST had slightly lower sensitivity of 80% (95%CI:59-93). Median time to detection of MDR-TB was