Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand
Issued Date
2022-07-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-85135082850
Pubmed ID
35895742
Journal Title
PLoS ONE
Volume
17
Issue
7 July
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS ONE Vol.17 No.7 July (2022)
Suggested Citation
Pongpeeradech N., Kasetchareo Y., Chuchottaworn C., Lawpoolsri S., Silachamroon U., Kaewkungwal J. Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand. PLoS ONE Vol.17 No.7 July (2022). doi:10.1371/journal.pone.0271130 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86498
Title
Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand
Other Contributor(s)
Abstract
GeneXpert MTB/RIF is a reliable molecular diagnostic tool capable of detecting Mycobacterium tuberculosis (MTB) and identifying genetic determinants of rifampicin (RIF) resistance. 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. 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. 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. 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. 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. 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. 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. Therefore, physicians still used the results of other conventional tests in their decision-making process. 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.