Since December 2010, the WHO has endorsed a novel molecular test, GeneXpert MTB/RIF, be used for the diagnosis of TB and TB resistance in TB-endemic countries. Although the nucleic acid amplification test (NAAT) has been recommended for the routine evaluation of TB in patients since 1996, this recommendation has not been implemented widely. Molecular tests for TB and MDR-TB have developed remarkably owing to the major challenges faced by countries with high TB burden, the emergence of MDR-TB, and highly drug-resistant tuberculosis (XDR-TB) worldwide. The clinical features of TB are nonspecific, so that rapid, simple, and accurate diagnostic tools for patients at high risk of TB and MDR-TB, and those with smear-negative pulmonary tuberculosis (PTB), have been recommended. Prompt and adequate TB diagnosis is essential for optimal TB control strategies, resulting in the early treatment of patients with TB and multidrug-resistant tuberculosis (MDR-TB). Delayed diagnosis is a significant cause of increased mortality in TB patients, especially HIV patients with smear-negative TB tests. The prevalence of TB has also been rising in a group of presumptive cases with negative smears in countries with high HIV burden, where TB mutations causing drug-resistant TB have been increasing. The World Health Organization (WHO) estimated that a third of the world’s population has been infected with Mycobacterium tuberculosis (MTB) even after the development of high-tech screening tools and advances in the treatment of tuberculosis (TB), especially in the developing world. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the paper and its Supporting Information files.įunding: The authors received no specific funding for this work.Ĭompeting interests: The authors have declared that no competing interests exist.Ĭenters for Disease Control and Prevention CXR, Received: JanuAccepted: JPublished: July 27, 2022Ĭopyright: © 2022 Pongpeeradech et al. PLoS ONE 17(7):Įditor: Dwij Raj Bhatta, Tribhuvan University, NEPAL It is recommended that GeneXpert MTB/RIF should be established at all points of care and be used as the initial test for PTB and MDR-TB diagnosis.Ĭitation: Pongpeeradech N, Kasetchareo Y, Chuchottaworn C, Lawpoolsri S, Silachamroon U, Kaewkungwal J (2022) Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand. Therefore, physicians still used the results of other conventional tests in their decision-making process. Despite its high sensitivity for detecting PTB and MDR-TB, GeneXpert MTB/RIF had contradictory results (false positive and/or false negative) for 21.8% of cases among patients with negative smear results and 41.1% of cases among patients with high risk of MDR-TB. Approximately one-fourth of the patients with negative CXR/smear and GeneXpert MTB/RIF results were diagnosed with PTB by the physicians, who based their decisions on other evidence, such as clinical symptoms, and did not use GeneXpert MTB/RIF as a “rule-out test.” GeneXpert MTB/RIF proved effective in early detection within a day, thereby radically shortening the time required to initiate second-line drug treatment. The physicians used it as a “rule-in test” for all patients with negative chest X-rays (CXR) and smear results, to ensure timely treatment. GeneXpert MTB/RIF was routinely used to assist the physicians in their decision-making for the diagnosis of pulmonary tuberculosis (PTB) and the initiation of MDR-TB treatment. A total of 2,030 complete TB records from 2 patient groups were reviewed, including 1443 suspected cases with negative smear results and 587 with high risk of MDR-TB. This study employed a mixed method: data were collected retrospectively from the medical records of TB patients and in-depth interviews were conducted with healthcare workers in areas with a high TB burden in Thailand. This study aimed to assess physicians’ diagnostic decision-making processes for TB based on GeneXpert MTB/RIF results and how this affected the initiation of multidrug resistance (MDR) treatment. GeneXpert MTB/RIF is a reliable molecular diagnostic tool capable of detecting Mycobacterium tuberculosis (MTB) and identifying genetic determinants of rifampicin (RIF) resistance.
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