Justice K Boakye-Appiah1, Alexis R Steinmetz2, Peter Pupulampu3, Stephen Ofori-Yirenkyi4, Ishmael Tetteh1, Michael Frimpong5, Patrick Oppong1, Ohene Opare-Sem6, Betty R Norman6, Ymkje Stienstra7, Tjip S van der Werf7, Mark Wansbrough-Jones8, Frank Bonsu9, Joseph Obeng-Baah1, Richard O Phillips10. 1. Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana. 2. Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA. Electronic address: alexis.steinmetz@gmail.com. 3. Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana. 4. Microbiology Laboratory, Koforidua Regional Hospital, Koforidua Central Business District, Eastern Region, Ghana. 5. Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 6. Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 7. Department of Internal Medicine/Infectious Diseases, University of Groningen Medical Center, Groningen, The Netherlands. 8. Institute of Infection and Immunity, St. George's University of London, London, UK. 9. National TB Control Program, Ghana Health Service, Ministries, Accra, Ghana. 10. Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Abstract
OBJECTIVE/ BACKGROUND: Drug-resistant strains of tuberculosis (TB) represent a major threat to global TB control. In low- and middle-income countries, resource constraints make it difficult to identify and monitor cases of resistance using drug susceptibility testing and culture. Molecular assays such as the GeneXpert Mycobacterium tuberculosis/rifampicin may prove to be a cost-effective solution to this problem in these settings. The objective of this study is to evaluate the use of GeneXpert in the diagnosis of pulmonary TB since it was introduced into two tertiary hospitals in Ghana in 2013. METHODS: A 2-year retrospective audit of clinical cases involving patients who presented with clinically suspected TB or documented TB not improving on standard therapy and had samples sent for GeneXpert testing. RESULTS: GeneXpert identified 169 cases of TB, including 17 cases of rifampicin-resistant TB. Of the seven cases with final culture and drug susceptibility testing results, six demonstrated further drug resistance and five of these were multidrug-resistant TB. CONCLUSION: These findings call for a scale-up of TB control in Ghana and provide evidence that the expansion of GeneXpert may be an optimal means to improve case finding and guide treatment of drug-resistant TB in this setting.
OBJECTIVE/ BACKGROUND: Drug-resistant strains of tuberculosis (TB) represent a major threat to global TB control. In low- and middle-income countries, resource constraints make it difficult to identify and monitor cases of resistance using drug susceptibility testing and culture. Molecular assays such as the GeneXpert Mycobacterium tuberculosis/rifampicin may prove to be a cost-effective solution to this problem in these settings. The objective of this study is to evaluate the use of GeneXpert in the diagnosis of pulmonary TB since it was introduced into two tertiary hospitals in Ghana in 2013. METHODS: A 2-year retrospective audit of clinical cases involving patients who presented with clinically suspected TB or documented TB not improving on standard therapy and had samples sent for GeneXpert testing. RESULTS: GeneXpert identified 169 cases of TB, including 17 cases of rifampicin-resistant TB. Of the seven cases with final culture and drug susceptibility testing results, six demonstrated further drug resistance and five of these were multidrug-resistant TB. CONCLUSION: These findings call for a scale-up of TB control in Ghana and provide evidence that the expansion of GeneXpert may be an optimal means to improve case finding and guide treatment of drug-resistant TB in this setting.
Authors: David J Horne; Mikashmi Kohli; Jerry S Zifodya; Ian Schiller; Nandini Dendukuri; Deanna Tollefson; Samuel G Schumacher; Eleanor A Ochodo; Madhukar Pai; Karen R Steingart Journal: Cochrane Database Syst Rev Date: 2019-06-07