Trends of Mycobacterium tuberculosis and Rifampicin resistance in Northwest Ethiopia: Xpert® MTB/RIF assay results from 2015 to 2021

Rifampicin-resistant Mycobacterium tuberculosis and unsuccessful results from Xpert® MTB/Rif-Ultra assay in Amhara Region, Ethiopia

Background

Tuberculosis, an infectious disease caused by Mycobacterium tuberculosis (Mtb), causes 10 million new infections and 1.3 million deaths annually. The treatment of TB is hampered by the increasing incidence rate of drug resistance associated with TB. To diagnose TB and identify drug-resistant TB cases, rapid molecular technologies such as Xpert MTB/RIF, Truenat MTB, MTB Plus, and MTB-RIF Dx tests are recommended by the World Health Organization (WHO) and rolled out globally. Xpert MTB/RIF-Ultra assay is the most widely used in developing countries like Ethiopia. However, this rapid technology has inherent limitations, such as error reports, invalid results, and no results collectively reported as unsuccessful tuberculosis results. The purpose of this study was to retrospectively evaluate the trend of rifampicin resistance and unsuccessful results in the Xpert MTB/RIF-Ultra assay facility of Northwest Ethiopia.

Methods

Retrospective data archived in the Amhara Public Health Institute (APHI) TB laboratory from 2019 to 2024 were reviewed. Xpert MTB/RIF-Ultra software data were retrieved and transferred to Microsoft Excel. Then, it was checked for completeness, cleaned manually, and imported to Statistical Package for the Social Sciences (SPSS) version 25 software. The rate of mycobacterium tuberculosis (Mtb.) positives, multi-drug resistance tuberculosis (MDR-TB), and Unsuccessful results were analyzed from the total and year-wise. The final results were depicted using tables and different charts.

Results

From June 30, 2019, to June 30, 2024, a total of 587,128 sputum samples were obtained from presumptive TB patients in 111 GeneXpert sites in the Amhara Region. Of these samples analyzed using Xpert MTB/RIF-Ultra, 6.17 % (36,212/587,128) were Mtb positive. Furthermore, the overall proportion of rifampicin resistance (RR) among Mtb-confirmed cases decreased to 3.03 % (1,096/36,212) and showed a downward trend from 4.62 % (184/3979) in 2020 to 2 % (176/8806) in 2024. The overall unsuccessful results (error, invalid & no result) were 6.48 %. The rate of unsuccessful results remained above the national target of < 5 % throughout the study periods.

Conclusion and recommendation

The rate of Mtb and MDR-TB showed a decreasing trend in the last six years in Northwest Ethiopia. However, unsuccessful results remained above the national target. The cause of unsuccessful results should be investigated, and the Xpert MTB/RIF-Ultra-related quality assurance system must be enhanced to reduce the rate of Xpert MTB/RIF-Ultra unsuccessful results.

Detection of Rifampicin Resistance rpoB Gene Using GeneXpert MTB/RIF Assay in Pulmonary Tuberculosis Cases at Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia

BACKGROUND

Tuberculosis (TB) is a preventable and treatable disease leading to the second death globally. The evolution of drug resistance in Mycobacterium tuberculosis (MTB), particularly rifampicin resistance (RR), has hampered TB control efforts. Thus, this study aimed to provide information regarding the magnitude of MTB and rifampicin resistance among patients tested using the GeneXpert method.

METHODS

A retrospective analysis was carried out at DTCSH. The study included TB registration logbook data from all patients who visited the hospital and were tested for MTB with the Xpert MTB/RIF assay from 2017 to 2024. The laboratory-based data were entered, cleaned, and analyzed using SPSS version 26 software. Multilogistic regression analysis was employed, and a p value ≤ 0.05 was considered statistically significant.

RESULTS

A total of 12,981 patient results were included, of which 8.9% (1160/12,981) were MTB-positive and 7.1% (82/1160) were RR. Individuals aged 15-29 years (AOR = 2.13; 95% CI = 1.55-2.93, p < 0.001), living in rural areas (AOR = 1.23; 95% CI = 1.08-1.41, p = 0.003), and HIV+ (AOR = 1.79; 95% CI = 1.48-2.33, p < 0.001) had a higher risk of developing tuberculosis. While RR was identified in 63.4% (52/82) of new, 24.4% (20/82) of re-treated, and 12.2% (10/82) of failed presumptive TB patients.

CONCLUSION

In this study, MTB and RR trends were high. Productive age groups, rural populations, and HIV patients were at risk. To lessen the burden of this contagious and fatal disease, it is recommended to increase early diagnosis of drug-resistant TB and enhance infection control.

Multidrug-resistant tuberculosis: latest opinions on epidemiology, rapid diagnosis and management

PURPOSE OF REVIEW

This review addresses the escalating global challenge of multidrug-resistant tuberculosis (MDR-TB) in Sub-Saharan Africa, with a focus on its complex comorbidity with HIV/AIDS. Emphasizing the urgency of the issue, the review aims to shed light on the unique healthcare landscape shaped by the convergence of high prevalence rates and intersecting complexities with HIV/AIDS in the region.

RECENT FINDINGS

A notable increase in MDR-TB cases across Sub-Saharan Africa is attributed to challenges in timely diagnoses, treatment initiation, and patient treatment defaulting. The literature underscores the critical need for proactive measures to address diagnostic and treatment gaps associated with MDR-TB, particularly concerning its comorbidity with HIV/AIDS.

SUMMARY

To effectively manage MDR-TB and its co-morbidity with HIV/AIDS, proactive screening programs are imperative. The review highlights the necessity of active follow-up strategies to ensure treatment adherence and reduce default rates, offering evidence-based insights for improved disease management in the region.