Xpert MTB/RIF assay for the diagnosis of Mycobacterium tuberculosis and its Rifampicin resistance at Felege Hiwot and Debre Tabor Hospitals; Northwest Ethiopia: A preliminary implementation research

Abstract

Background: The World Health Organization in 2010 indorsed Xpert MTB/RIF (Xpert) assay for the diagnosis of tuberculosis and multidrug resistant tuberculosis. However, the use of this novel diagnostic method is still limited in a high TB and human immunodeficiency virus burden settings including Ethiopia. Therefore, we conducted this study to describe the first implementation result of Xpert assay in the diagnosis of TB, TB/HIV and MDR-TB at Felege Hiwot Referral Hospital (FHRH) and Debre Tabor General Hospital (DTGH), Northwest Ethiopia. Methods: We analyzed the records of 1922 (FHRH=544 and DTGH=1378) presumptive TB patients diagnosed using Xpert test from 2015 to 2016 at FHRH and DTGH, Northwest Ethiopia. Information on the demographic and clinical data was collected. Data were entered, cleared, and analyzed using SPSS statistical software package; p < 0.05 was considered to be significant. Results: Overall Xpert assay properly diagnosed 14.6% of the cases (258/1922). Among this rifampicin (RIF) resistance was detected at 9.3% (24/258) of the cases. In the studied region, clinical data reported that 81.0% (1556/1922) of the cases were MDR- TB. Among the study subjects, 888 (46.2 %) of them were HIV positive. TB-HIV co- infection rate was at 41.9% (108/258). Of the total patients registered, 1005 (52.3%) of whom were males. The mean age of patients was 31.1 years with SD of 17.5. Significant predictors of the Xpert test were: age (p=0.000), sex (p=0.009), HIV (p=0.003) and presumptive MDR-TB (p=0.000). Conclusions: In the studied areas, large proportion of clinically TB suspected patients were wrongly diagnosed with multidrug resistant TB. Therefore, the use of Xpert assay in health settings with no culture facility will decrease the unnecessary use of anti-TB drugs and improve rapid TB, TB/HIV and MDR-TB detection and proper management of the cases.