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Xpert® MTB/RIF for national tuberculosis programmes in low-income countries: when, where and how?
- Source :
-
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease [Int J Tuberc Lung Dis] 2011 Dec; Vol. 15 (12), pp. 1567-72. Date of Electronic Publication: 2011 Oct 13. - Publication Year :
- 2011
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Abstract
- 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.
- Subjects :
- Algorithms
Developing Countries
Drug Resistance, Bacterial
Humans
Microbial Sensitivity Tests
Mycobacterium tuberculosis drug effects
National Health Programs
Nucleic Acid Amplification Techniques economics
Sputum microbiology
Tuberculosis drug therapy
Tuberculosis microbiology
Antitubercular Agents pharmacology
Nucleic Acid Amplification Techniques methods
Rifampin pharmacology
Tuberculosis diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1815-7920
- Volume :
- 15
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
- Publication Type :
- Academic Journal
- Accession number :
- 22005110
- Full Text :
- https://doi.org/10.5588/ijtld.11.0392