Prevalence of rifampicin resistant Mycobacterium tuberculosis among presumptive tuberculosis patients in selected governmental hospitals in Addis Ababa, Ethiopia

Mycobacterium tuberculosis and rifampicin-resistant tuberculosis among tuberculosis presumptive patients in selected zones of Tigray, Northern Ethiopia, 2016-2019

Introduction

Tuberculosis (TB) is the second leading cause of mortality from an infectious disease worldwide. Multidrug-resistant tuberculosis (MDR-TB), where rifampicin-resistant TB is the biggest contributor, remains a global health threat. There is scant data on MTB and rifampicin resistance (RR-MTB) using Gene Xpert MTB/RIF assay in Ethiopia. This study aimed to determine the prevalence of MTB and RR-MTB among presumptive TB patients in Tigray, Northern Ethiopia.

Methods

A multi-center retrospective cross-sectional study was conducted from October 2019 to December 2019 among presumptive MTB patients from four hospitals in Tigray. Records of sputum sample results of presumptive MTB patients analyzed with Gene Xpert MTB/RIF assay from January 2016 to December 2019 were investigated. Data were extracted using a data-extraction tool from registration books and analyzed using SPSS ver.21. Statistically significant was set at p-value ≤0.05.

Results

From 17,329 presumptive adult MTB patients who had submitted sputum samples for TB diagnosis, 16,437 (94.9 %) had complete records and were included in the study. More than half (60.2 %) of them were males and ages ranged from 18 to 98 years. Majority of the participants: 15,047(91.5 %) were new cases and 11,750 (71.5 %) were with unknown HIV status. Prevalence of MTB was 9.7 % (95 % CI: 9.2-10.2 %) of these, rifampicin resistant-MTB was 8.7 % (95 % CI: 7.32-10.09 %). Age (being >29 years) [p < 0.001] and new cases [AOR = 0.46; 95%CI = 0.39, 0.53, p < 0.001] were associated with low TB infection. Age groups of 18-29 years were associated with higher RR-MTB [AOR = 3.08; 95 % CI = 1.07, 8.72, p = 0.036].

Conclusion

Nearly one-tenth of the presumptive tuberculosis patients tested positive for MTB; out of these, 8.7 % were RR-MTB. The high prevalence of TB and RR-MTB at a young age and previously treated cases calls for a concerted effort to improve and monitor TB treatment to reduce the problem.

Trends of Mycobacterium tuberculosis and rifampicin resistance at the Ho Teaching Hospital in Ghana

BACKGROUND

Tuberculosis remains a major public health threat worldwide, causing significant morbidity and mortality, particularly in low- and middle-income countries. In recent years, efforts to combat tuberculosis have focused on strengthening healthcare systems and increasing access to diagnostics and treatment services. There is scarcity of data on the prevalence of Mycobacterium tuberculosis and rifampicin-resistant tuberculosis in the Volta region of Ghana. Therefore, the aim of this study was to determine the trends of Mycobacterium tuberculosis and rifampicin resistance in a major teaching hospital in Ghana spanning a six-year period.

METHODOLOGY

A retrospective cross-sectional hospital study was conducted at Ho Teaching Hospital, Ho, Ghana. Study data included archived results on tuberculosis testing using GeneXpert from 2016-2021. Archived data on tuberculosis testing were collected and entered using Microsoft Excel 2019. IBM SPSS (v26) was used for a statistical analysis of the prevalence of tuberculosis. P-value <0.05 was considered statistically significant.

RESULTS

The study included 5128 presumptive tuberculosis cases from 2016 to 2021, of which 552 were positive, revealing an overall prevalence of 10.76%. Males exhibited a significantly higher prevalence of tuberculosis (14.20%) compared to females (7.48%), with a male-to-female ratio of 2:1. The burden of tuberculosis varied significantly between age groups, with those aged 30-45 years and 46-60 years facing twice the risk compared to those under 15 years (p<0.001). Rainy seasons correlated with heightened tuberculosis occurrences (12.12%) compared to dry seasons (8.84%) (p = 0.008). Rifampicin-resistant tuberculosis was prevalent at 3.45%, slightly higher in women, particularly in the 45-59 age group (5.97%). In particular, tuberculosis prevalence exhibited fluctuations, peaking in 2016 (17.1%) and 2020 (11.5%), with a trough in 2019 (4.6%).

CONCLUSION

The overall prevalence of laboratory confirmed tuberculosis was 10.76%, and resistance to rifampicin, 3.45%, indicating high infection and possible treatment failure. Considering its infectious nature, this calls for concerted efforts to curb the spread of the infection.

Molecular detection of rifampicin-resistant Mycobacterium tuberculosis by polymerase chain reaction in Ethiopia: a systematic review and meta-analysis

Introduction

Tuberculosis is a contagious bacterial disease caused by Mycobacterium tuberculosis. The emergence and spread of drug-resistant strains of M. tuberculosis in both developing and developed countries has made diagnosis, treatment, and control of tuberculosis more difficult. The PCR assay, which is a fast and sensitive technique and an alternative method for detecting multidrug-resistant tuberculosis, is used to determine rifampicin (RIF) resistance. There is no single figure in Ethiopia that represents rifampicin-resistant tuberculosis and that is why this study was conducted to overcome the inconsistency of the results of the previous studies.

Methods

Studies were researched from five major electronic databases. Studies which were cross-sectional in design, published, and written in English were included. The data were extracted using Microsoft Excel, and the data were managed and analyzed using Stata™ Version 17.0 statistical software. The Forest plot was used to check the presence of heterogeneity. The publication bias, meta-regression, and subgroup analysis were used to find out the source of heterogeneity. A random effect analysis model was used to pool the prevalence of RR TB from primary studies, and associated factors of RR among TB patients were identified using Meta regression. The presence of association was reported using OR with 95% CI.

Results

The overall pooled prevalence of tuberculosis was 14.9% (95% CI: 13.34, 16.46), of these approximately 7.48% (95% CI: 6.30, 8.66) showed rifampicin-resistant tuberculosis in Ethiopia. Among the computed variables, 2.05% living with HIV1.39 (95%CI: 1.13, 1.72) and having a history of TB treatment (95%CI: 1.34, 3.15) were identified as significant factors associated with RR TB in Ethiopia.

Conclusion

Drug-resistant TB is one of the prevalent emerging infectious diseases among TB patients, which affects approximately one out of every thirteen TB patients. Having TB-HIV coinfection and a history of prior TB treatment were identified as significant factors associated with RR TB. To prevent and control RR TB, patients should complete their follow-up course; the health professionals should educate the actions taken by the patients when they experience drug toxicity and side effects; and the Minister of Health should initiate telemedicine and recruit tracers to overcome TB patients' default and have good drug adherence and retention after initiation of the treatment.

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

BACKGROUND

Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide, particularly in countries with limited resources. The emergence of drug resistance in mycobacterium tuberculosis (MTB), particularly rifampicin (RIF) resistance, hindered TB control efforts. Continuous surveillance and regular monitoring of drug-resistant TB, including rifampicin resistance (RR), are required for effective TB intervention strategies and prevention and control measures.

OBJECTIVE

Determine the trend of TB and RR-TB among presumptive TB patients in Northwest Ethiopia.

METHOD

A retrospective study was conducted at the University of Gondar Comprehensive Specialized Hospital (UoG-CSH). The study included TB registration logbook data from all patients who visited the hospital and were tested for MTB using the Xpert® MTB/RIF assay between 2015 and 2021. The SPSS version 26 software was used to enter, clean, and analyze the laboratory-based data.

RESULTS

A total of 18,787 patient results were included, with 93.8% (17,615/18787) of them being successful, meaning they were not invalid, error, or aborted. About 10.5% (1846/17615) of the 17,615 results were MTB-positive, with 7.42% (137/1846) RIF resistant. Age, anti-TB treatment history, and diagnosis year were associated with the presence of MTB and RR-MTB. Tuberculosis (TB) prevalence was higher in productive age groups, whereas RR-TB prevalence was higher in the elderly. Regarding diagnosis year, the prevalence of TB and RR-TB showed a declining trend as the year progressed. While MTB was detected in 12.8% (471/3669) of new and 22.2% (151/679) of re-treatment presumptive TB patients, RR-MTB was detected in 8.5% (40/471) of new and 18.5% (28/151) of re-treatment TB cases.

CONCLUSION

The prevalence of TB and RR-TB in the study area showed a declining trend over the years. While TB was more prevalent in productive age groups (15 to 45 years), RR-TB was more prevalent in older populations (over 45 years), than others. Moreover, patients with a history of anti-TB drug exposure were more likely to be positive for DR-TB, highlighting the need to strengthen DOT programs for proper management of TB treatment.

Prevalence of Rifampicin resistance tuberculosis among presumptive tuberculosis patients in Egypt-2021: a national health facility-based survey

BACKGROUND

The magnitude of MDR-TB cases was noticeable in Egypt. However, the last national survey was 11-years ago. The current survey was conducted to determine the prevalence of rifampicin resistance among sputum smear-positive pulmonary tuberculosis patients in Egypt.

METHODS

A national health facility-based cross-sectional study was conducted in 14 randomly selected governorates in Egypt between August 2020 and September 2021. All presumptive TB cases, either new or previously treated according to WHO definitions, with no gender, age, or nationality limitations, and provided informed consent were included in the study. Each patient completed a case report form (CRF). The CRF included socio-demographic and clinical data. Sputum samples were collected according to standard techniques and cultured on Lowenstein-Jensen (L-J) medium. Gene X-pert test was carried out first on the samples for simultaneous identification of MTB and rifampicin resistance. The prevalence of RR was calculated using crude, cluster, and weighted methods. Factors associated with RR were analyzed by bivariate and multivariate techniques.

RESULTS

Among the total 849 presumptive TB patients enrolled in the study, 710 (83.6%) patients were subjected to Gene X-pert testing (MTB/RIF). The crude prevalence of RR was 3.32% (95% CI: 1.89-4.76%) among the new cases and 9.46% (95% CI: 2.63-16.29%) among the retreated cases with an overall estimate of 3.99%; (95% CI: 2.51-5.47%). By cluster analysis the overall prevalence of RR was 5.01% (95% CI: 2.90-7.13). Factors associated with the prevalence of RR were co-morbidity with bronchial asthma, drug abuse and history of contact with a family member with TB.

CONCLUSION

The prevalence of RR among either new or retreated cases TB patients was lower than the previous Egyptian rates in 2010-2012. The strongest predictor associated with RR was comorbidity with bronchial asthma.

Pulmonary Tuberculosis and Rifampicin Resistant Mycobacterium Tuberculosis in Children and Adolescents using Gene Xpert MTB/RIF Assay in Tigray, Northern Ethiopia

Background

Tuberculosis (TB) continues to be a global health problem. While childhood TB contributes 10% to the global TB burden, the paucibacillary nature of TB disease in children and the absence of reliable diagnostic methods have made MTB diagnosis in children to be a great challenge. This study aimed to determine the prevalence of MTB and rifampicin-resistant MTB (RR-MTB) among children using Gene Xpert MTB/RIF Assay in Tigray, Ethiopia.

Methods

A retrospective database study was conducted among children in ten governmental hospitals in the Tigray region. Gene Xpert MTB/RIF results of sputum/gastric lavage samples from children with presumptive TB from January 2016 to December 2019 were extracted using a data extraction sheet. Data were collected and analyzed using Statistical Package for the Social Sciences version 21.

Results

The prevalence of bacteriologically confirmed MTB by Gene-Xpert in children with presumptive TB was 7.3% (95% CI: 6.7%-7.9%) and the proportion of those that were Gene-Xpert MTB positive who also have rifampicin resistance was 10.9% (95% CI: 8.2-13.6%). Older children aged 11-15 years [AOR = 1.76; 95% CI = 1.33-2.33, p < 0.001] and adolescents 16-17 years [AOR = 2.18; 95% CI = 1.63-2.92, p < 0.001] were more likely to be MTB positive. Relapse cases [AOR = 1.66; 95% CI = 1.09-2.51, p = 0.017] and lost/failure cases [AOR = 8.82; 95% CI = 3.94-19.76, p < 0.001] were more likely to have MTB compared to the new cases.

Conclusion

The proportion of MTB-positive among the TB presumptive patients was 7.3%. The proportion of rifampicin-resistant TB to all positive patients was 10.9%. Female participants had more MTB than males (or younger children). The result highlights the need for due attention in children because it is very helpful in determining the future control of the disease.

Magnitude of tuberculosis lymphadenitis, risk factors, and rifampicin resistance at Adama city, Ethiopia: a cross-sectional study

Mycobacterium tuberculosis complex has an impact on public health and is responsible for over one million deaths per year. Substantial numbers of people infected with M. tuberculosis can develop tuberculosis lymphadenitis; however, there is a limited study in Adama, Ethiopia. The aim of this study was to determine the magnitude of Tuberculosis lymphadenitis, its predictors, and rifampicin-resistance gene-positive M. tuberculosis. A total of 291 patients with enlarged lymph nodes were recruited from May 2022 to August 30 at Adama Comprehensive Specialized Hospital Medical College (ACSHMC). GeneXpert, Ziehl-Neelsen staining, and cytology were used for the diagnosis of TB lymphadenitis from the Fine Needle Aspirate (FNA) specimen. Rifampicin-resistant gene was detected using GeneXpert. For data entry and analysis, Epi Data version 3.0 and SPSS version 25 were used respectively. A binary logistic regression model was used to identify predictors of TB lymphadenitis. A p < 0.05 with a 95% confidence interval (CI) was taken as a cut point to determine the significant association between dependent and independent variables. The prevalence of TB lymphadenitis using GeneXpert, Ziehl-Neelsen staining, and cytology were 138 (47.4%) (95% CI 41.70-53.10), 100 (34.4%) (95% CI 28.94-39.85), and 123 (42.3%) (95% CI 36.63-47.00) respectively. Nine (3.1%) participants were infected with rifampicin-resistant gene-positive M. tuberculosis. Out of the total M. tuberculosis detected by GeneXpert (n = 138), 9 (6.5%) were positive for rifampicin resistance-gene. Participants with a chronic cough had 2 times odds of developing TB lymphadenitis (AOR: 2.001, 95% CI 1.142-3.508). Close to half of patients with enlarged lymph nodes were positive for M. tuberculosis by the GeneXpert method in the study area. Chronic cough was significantly associated with TB lymphadenitis. Rifampicin-resistant gene-positive M. tuberculosis was relatively prevalent among patients with enlarged lymph node in the study area.

Prevalence of rifampicin resistant pulmonary tuberculosis using geneXpert assay in Ethiopia, a systematic review and meta-analysis

Background

Drug-resistant tuberculosis continues to be a global public health threat. Ethiopia is one of the high-burden countries for tuberculosis and multi-drug resistant tuberculosis. The estimated annual incidents of tuberculosis were 119 per 100,000 populations in 2021 and the prevalence of multi-drug resistance tuberculosis is about 0.7% among newly diagnosed cases in Ethiopia. On time detection of rifampicin resistance is essential for the management of the disease and earlier treatment initiation. Among the different diagnostic tests; Xpert is widely used for the rapid detection of Mycobacterium tuberculosis and rifampicin resistant in the country. The prevalence of rifampicin resistance-pulmonary tuberculosis varied from locality to locality and the estimated national prevalence of rifampicin resistance pulmonary tuberculosis is not available in the country. Therefore, the aim of this meta-analysis was to summarize the results of available studies and generate pooled prevalence estimate of rifampicin resistance pulmonary tuberculosis in Ethiopia.

Methods

Literature search was carried out using PubMed and Scopus public databases. Original articles conducted in Ethiopia and those containing a prevalence report of rifampicin resistance pulmonary tuberculosis diagnosed by Xpert Mycobacterium tuberculosis/rifampicin resistance assay were included in the meta-analysis. All retrospective and prospective studies published until May 2022 were screened in the study. The methodological qualities of included article were assessed using Joanna Briggs Institute quality assessment tool for cross-sectional studies. Random effect model was used to determine the pooled prevalence of rifampicin resistance pulmonary tuberculosis. Subgroup analysis and regression were carried out across regional states and study designs. Heterogeneity across studies was assessed using I2 test. The data were analyzed using STATA version 14.

Result

A total of 1570 titles were identified and 34 studies met the inclusion criteria. Of the total 17,292 pulmonary tuberculosis patients who were identified from the included articles, 1669 were rifampicin resistance pulmonary tuberculosis. The pooled prevalence of rifampicin resistant among pulmonary tuberculosis patients diagnosed with Xpert Mycobacterium tuberculosis/rifampicin resistance assay was 9.67% (95% CI: 8.11-11.24). The highest pooled prevalence was from Oromia11.84% (95% CI: 4.49-19.2%) and the lowest rifampicin resistance was identified in Amhara Regional State, 8.51% (95% CI: 5.96-11.06%). The pooled prevalence rates of rifampicin resistant among pulmonary tuberculosis patients were 10.18% (95% CI: 6.85-13.51) and 9.57% (95% CI: 7.68-11.47) in prospective and retrospective types of cross-sectional studies.

Conclusion

Our study showed that the pooled prevalence of rifampicin resistance among pulmonary tuberculosis patients was 9.67%. This showed that the occurrence of rifampicin resistance pulmonary tuberculosis among Mycobacterium tuberculosis patients remains high in Ethiopia. Regional state wise, rifampicin resistance variation was small. Further meta-analysis of factors associated with rifampicin resistance among pulmonary tuberculosis patients as well as among extrapulmonary Mycobacterium tuberculosis cases should be carried out.

Prevalence of tuberculosis and associated factors among presumptive TB refugees residing in refugee camps in Ethiopia

BACKGROUND

Tuberculosis (TB) causes significant morbidity and mortality in refugee populations. Although Ethiopia is the third largest refugee-hosting country in Africa, there is limited published data on the prevalence and associated factors of TB in refugees. The objective of this study was to estimate the prevalence of bacteriologically confirmed pulmonary TB (PTB) and explore associated factors in presumptive TB refugees residing in refugee camps in Ethiopia.

METHODS

A facility-based cross-sectional study was conducted between February and August 2021 in refugee camps in Ethiopia. Data were collected consecutively from 610 presumptive TB refugees who attended for TB diagnosis in selected refugee camp clinics in Ethiopia. A pre-tested questionnaire was used to collect data, and sputum samples were collected from eligible study participants. The Xpert Mycobacterium tuberculosis (MTB)/Rifampicin (RIF) assay was performed on direct spot sputum samples, whereas morning sputum samples were processed and inoculated for bacteriological culture using Mycobacterium Growth Indicator Tube (MGIT) and Lowsteen Jensen (LJ) methods. The statistical software package (STATA version 14) was used for statistical analysis. A logistic regression model was used for the evaluation of the association between bacteriologically confirmed TB cases and the associated factors. Descriptive statistics were used for the expression of the results, and statistical significance was assumed at p < 0.05.

RESULTS

Out of 610 study participants, more than half were female (54.9%), and the mean age was 37.9 years (SD, 16.64). The prevalence of bacteriologically confirmed PTB cases among refugees residing in refugee camps in Ethiopia was 13.3% (95% CI, 10.7-16.2%) using the Xpert MTB/RIF assay and/or culture. MTB was detected in 12.8% (95% CI, 10.2-15.7%) of the individuals using the Xpert MTB/RIF assay, while culture positivity was observed in 11.6% (95% CI, 9.2-14.5%). The multivariable logistic regression model showed South Sudan origins (adjusted odds ratio, AOR = 7.74; 95% CI, 3.05-19.64), age group, 19-38 years old (AOR = 5.66; 95% CI, 1.86-17.28), and male sex (AOR = 2.69; 95% CI, 1.58-4.56) were significantly associated with the bacteriologically confirmed TB among refugees residing in refugee camps in Ethiopia.

CONCLUSION

The prevalence of bacteriologically confirmed PTB among presumptive TB refugees residing in refugee camps in Ethiopia was high. The national TB program should strengthen TB prevention and control activities in the refugee camps of Ethiopia. Moreover, an active TB survey program should be implemented in refugee camps in Ethiopia.

Frequency of rifampicin-resistant mycobacterium tuberculosis by GeneXpert MTB/RIF assay and its correlates among 2605 probable tuberculosis patients in upper Egypt

RATIONALE

GeneXpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) assay is a method for detecting rifampicin resistance (RR-MTB) in suspected samples in less than 2 hours with high sensitivity and specificity yield. This study aimed to use the GeneXpert MTB/RIF assay to determine the frequency of RR-MTB and to study the possible influencing correlates associated with positive results.

SUBJECTS AND METHODS

This is a retrospective cross-sectional study of patients who visited TB clinic in 5 years (2016-2021). According to the data sheet of the patients, all the collected specimens were divided into 2 parts one for diagnosis by Ziehl-Neelsen stain and the other part for GeneXpert analysis. GeneXpert was also used to look for evidence of RR.

RESULTS

Out of the 2605 total samples screened, 718 (27.6%) tested positive for MTB on GeneXpert assay; of them 633 (88.4%) were sensitive to Rifampicin, 83 (11.6%) were resistant to Rifampicin and 2 cases were undetermined. Factors contributing to RR-MTB were: smoker/ex-smoker, with 2.5 times more risk (p = 0.013.0, p = 0.001); recurrence cases had a 4-fold increased risk (p < 0.001); patients with very low M. tuberculosis detected on the GeneXpert MTB/RIF test were 8 times more likely to have RR-TB (P = 0.004).

CONCLUSION

This study disclosed a high-rate MTB in Egyptian probable TB cases. Smoking, recurrence and cases with a very low M. tuberculosis burden noticed on the GeneXpert MTB/RIF test had augmented risk of RR-TB.

Prevalence of Hepatitis B Virus, Human Immune Deficiency Virus and Associated Risk Factors Among Individuals with Presumptive Pulmonary Tuberculosis Attending at Saint Peter's Specialized Hospital, Addis Ababa, Ethiopia

Background

Hepatitis B virus (HBV), human immunodeficiency virus (HIV) and tuberculosis are the causes of widely spread infectious disease, especially in resource-limited countries. The extent of HBV infection and its contributing factors among people with suspected pulmonary tuberculosis (PTB) were not adequately addressed.

Objective

To assess the prevalence of HBV, HIV & their associated risk factors and the magnitude of TB among individuals with presumptive pulmonary tuberculosis attending at St. Peter's Specialized Hospital, Addis Ababa, Ethiopia.

Methods

A cross-sectional study was conducted among 387 individuals with presumptive PTB from October to December 2020. A standard questionnaire was used to collect socio-demographic data and associated risk factors. Sputum samples were analyzed by GeneXpert, Florescent Microscopy and Ziehl-Nelson staining technique. HBsAg test was carried out using Murex Version 3 ELISA test kit from serum/Plasma samples, HIV testing was performed by rapid HIV test kits and data were analyzed using SPSS version 23.

Results

The mean age of study participants was 44.2 years. Overall, 14 (3.6%), 28 (7.2%) and 37 (9.6%) of them were positive for HBV, HIV & TB, respectively. Only single patient was HBV-HIV co-infected (0.3%). The TB-HIV co-infection was identified in 6 (1.6%). In multivariate analysis, being partner separated, alcohol consumption, body piercing and having multiple sexual partners were significantly associated with HBV infection. Having a spouse, who is divorced, widowed, sharing scissors, alcohol consumption and contact with multiple sexual partners also significantly associated with HIV infection.

Conclusion

This study showed that HBV, HIV and TB are still public health issues that need awareness and health education on the risky behaviors and transmission of HBV, HIV & TB among individuals with presumptive TB suspects. Further large-scale study is necessary.

Rifampicin resistant Mycobacterium tuberculosis and associated factors among presumptive pulmonary tuberculosis patients in Mogadishu, Somalia

Background

Multi-drug resistant Mycobacterium tuberculosis is a growing public health problem in developing countries including Somalia. Although, the prevalence of multi-drug resistant tuberculosis among new and retreated cases is high, data on GeneXpert- Mycobacterium tuberculosis/rifampicin-resistant assay, which is a surrogate marker for multidrug resistance, is not well explored in Mogadishu.

Objectives

To determine the prevalence of rifampicin-resistant Mycobacterium tuberculosis and its associated factors among presumptive pulmonary tuberculosis patients visiting tuberculosis centers in Mogadishu, Somalia.

Methods

A multicenter cross-sectional study was conducted in three tuberculosis treatment centers from March 12 to April 30, 2021. Laboratory professionals collected sputum sample consecutively from presumptive pulmonary tuberculosis participants and performed a GeneXpert assay to determine the rifampicin resistance. Socio-demographic and clinical data were collected using structured questionnaire. Logistic regression analyses were performed to assess factors associated with rifampicin resistance using an adjusted odds ratio at a 95% confidence interval. Statistical significance was considered at a p-value of less than 0.05.

Results

A total of 370 presumptive tuberculosis suspects were included; of whom 58.4% were females and the mean age of the participants was 44.3 ± 14 years. Mycobacterium tuberculosis was detected in 63 (17%) (95% confidence interval = 13.2-20.8) suspects. Of these the prevalence of rifampicin-resistant Mycobacterium tuberculosis was 35% (95% confidence interval = 30.2-39.8). Anti-tuberculosis treatment history (adjusted odds ratio = 4.1; 95% confidence interval = 1.91-6.75), monthly income less than $100 USD (adjusted odds ratio = 2.2; 95% confidence interval = 1.77-5.98) and being diagnosed with Asthma (adjusted odds ratio = 2.63; 95% confidence interval = 1.3-7.3) were significantly associated with rifampicin-resistant tuberculosis.

Conclusion

A considerable proportion of rifampicin-resistant tuberculosis is reported in these study settings. The strong association between multidrug resistance tuberculosis and patients' retreatment history of tuberculosis, low income, and co-morbidity with asthma highlights the need for more efforts in tuberculosis treatment and monitoring programs to limit the emergence of multi-drug resistant strain in the study areas.

High proportion of RR-TB and mutations conferring RR outside of the RRDR of the rpoB gene detected in GeneXpert MTB/RIF assay positive pulmonary tuberculosis cases, in Addis Ababa, Ethiopia

BACKGROUND

Globally, TB is the leading cause of infectious disease morbidity and mortality with many diagnostic uncertainties. Access to affordable and rapid diagnostics remained a major challenge for many developing countries which bear the greatest burden of TB delaying the initiation time to treatment.

OBJECTIVE

This study aimed to assess the GeneXpert MTBRIF assay probe utility for the detection of pulmonary TB and Rifampicin-resistant TB cases in Addis Ababa, Ethiopia.

MATERIALS AND METHODS

A cross-sectional study was performed from October 2019 to July 2020 in Saint Peter TB Specialized Hospital in Addis Ababa metropolitan area, Ethiopia. This study enrolled 216 clinically suspected new presumptive pulmonary TB cases confirmed by GeneXpert MTB/RIF Assay. Sociodemographic and clinical characteristics were captured using a structured tool. Data were entered in Microsoft Excel 2019, checked for inconsistency, cleaned promptly, and exported to IBM SPSS Statistics for Windows, Version 26.0. Armonk, N.Y: IBM Corp, the USA for analysis. Descriptive analysis and binary and multivariate logistics regression were performed and all statistical significance was determined at a 95% confidence level.

RESULTS

The majority of the study participants, 55.1% [119/216] were males aged 6-80 years. The prevalence of RR MTB was 11.11% [24/216]. A higher proportion of RR TB was found in female patients [54.2%, 13/24], in patients in the age group of 30-50 years [45.8%, 11/24], in married individuals [62.5%, 15/24], in persons whose residence is urban [79.2%, 19/24], in persons who had a previous history of TB symptoms [100%, 24/24], in persons who had a history of contact with active and LTBI [33.3%, 8/24], and in persons who had a history of HIV and IDUs [41.7%, 10/24]. Occupation (AOR 22.868, 95% CI 1.655-316.022, p = 0.019), history of previous PTB+ (AOR 4.222, 95% CI 1.020-17.47, p = 0.047), and history of HIV and IDUs (AOR 4.733, 95% CI 1.416-15.819, p = 0.012) were independent predictors associated with RR-TB emergence. The commonest mutation 62.5% [15/24] was found in probe E (codons 529-533) region. There was no mutation associated with probe A (codons 507-511), probe B (codons 511-518), and probe C (codons 518-523) regions, as well as no combination of missed probes, was revealed. However, 12.5% [3/24] of RR TB patients were found without unidentified missed probe types detected outside of the RRDR. The delta Ct max was >4.0 and the highest proportion of 35.6% [77/216] RR TB was detected in samples of medium DNA load.

CONCLUSION

The proportion of RR-TB we observed in this study was high. Similarly, a higher proportion of RR TB was detected outside of the RRDR. Moreover, a significant number of the GeneXpert MTB/RIF Assay probes were identified as unhybridized and this critical observation would mean that most of the probes had no or minimal utility in this geographical region. This calls for further studies to uncover mutation in the rpoB gene conferring RR and reshape TB triage and definite diagnostic algorithm in Ethiopia.

Detection of Mycobacterium tuberculosis and rifampicin resistance by Xpert® MTB/RIF assay among presumptive tuberculosis patients in Addis Ababa, Ethiopia from 2014 to 2021

Objective

This study aimed to determine the frequencies and trends of Mycobacterium tuberculosis and rifampicin resistance among presumptive tuberculosis patients in Ethiopia, who were tested using the Xpert MTB/RIF assay between 2014 and 2021.

Methods

Data were collected retrospectively from patient registries. Laboratory-based data were extracted from the national tuberculosis (TB) referral laboratory database. All patients referred to the National Tuberculosis Reference Laboratory (NTRL) for TB diagnosis from all over the country between March 1, 2014 and September 30, 2021, and tested using the Xpert MTB/RIF assay, were included. The extracted data were entered into a Microsoft Excel sheet and analyzed by Statistical Package for Social Sciences (SPSS) version 23.

Results

Among a total of 13 772 individuals tested using the Xpert MTB/RIF assay, the majority (8223; 59.7%) were males, and 48.5% (6678) of the individuals were aged between 15 and 39 years. Mycobacterium tuberculosis (MTB) was detected in 17.0% (2347) of the examined individuals. Of the detected MTB cases, nearly 9.9% (233) were rifampicin resistant (RR-TB), while 24 (1.0%) were RR-intermediate. Among all RR-TB cases, more than half (125; 53.6%) were detected in males, and 105 were new TB cases. Extrapulmonary (EPTB) patients had a greater rate of rifampicin resistance (11.0%) than pulmonary (PTB) patients (9.6%).

Conclusion

The frequency of TB and RR-TB remains high in the study setting. RR-TB was found to have a statistically significant association with previous anti-TB medication treatment. As a result, improving treatment adherence in recognized instances could assist in preventing MTB and RR-TB cases.

Risk factors associated with drug-resistant tuberculosis in Ethiopia: A systematic review and meta-analysis

The emergence of drug-resistant tuberculosis (DR-TB) is becoming a challenge to the national TB control programmes including Ethiopia. Different risk factors are associated with DR-TB. Identifying these risk factors in a local setting is important to strengthen the effort to prevent and control DR-TB. Thus, this study aimed to assess the risk factors associated with DR-TB in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed to conduct this study. We systematically searched the articles from electronic databases and grey literature sources. We used the JBI tools to assess the quality of studies. Data were analysed using STATA version 15. We estimated the pooled odds ratio (OR) along with 95% Confidence Interval (CI). The forest plot and I2 heterogeneity test were used to assess heterogeneity among studies. We explored the presence of publication bias through visual inspection of the funnel plot and Egger's regression test. After screening 2238 articles, 27 studies were included in the final analysis. Based on the pooled analysis of the OR, unemployment (OR; 2.71, 95% CI; 1.64, 3.78), previous TB history (OR; 4.83, 95% CI; 3.02, 6.64), contact with known TB patient (OR; 1.72, 95% CI; 1.05, 2.40), contact with the known multi-drug resistant (MDR) TB patient (OR; 2.54, 95% CI; 1.46, 3.63) and having pulmonary TB (PTB; OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of DR-TB, while elders (OR; 0.77, 95%CI; 0.60, 0.95) including above 45 years (OR; 0.76, 95%CI; 0.55, 0.97) and males (OR; 0.86, 95%CI; 0.76, 0.97) had lower DR-TB risk, compared to their counterparts. A previous history of TB treatment is a major risk factor for acquiring DR-TB in Ethiopia that might be due to poor adherence during the first-line anti-TB treatment. Besides, having contact with a TB patient, contact with an MDR-TB patient, having PTB and being unemployed were the risk factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for DR-TB might help to detect DR-TB cases as early as possible and could help to mitigate its further transmission across the community.

Tuberculosis Prevalence and Predictors Among Health Care-Seeking People Screened for Cough of Any Duration in Ethiopia: A Multicenter Cross-Sectional Study

Background

Tuberculosis (TB) remains a major cause of morbidity and mortality in sub-Saharan Africa. This high burden is mainly attributed to low case detection and delayed diagnosis. We aimed to determine the prevalence and predictors of TB among health care-seeking people screened for cough of any duration in Ethiopia.

Methods

In this multicenter cross-sectional study, we screened 195,713 (81.2%) for cough of any duration. We recruited a sample of 1,853 presumptive TB (PTB) cases and assigned them into three groups: group I with cough ≥2 weeks, group II with cough of <2 weeks, and group III pregnant women, patients on antiretroviral therapy, and patients with diabetes. The first two groups underwent chest radiograph (CXR) followed by sputum Xpert MTB/RIF assay or smear microscopy. The third group was exempted from CXR but underwent sputum Xpert MTB/RIF assay or smear microscopy. TB prevalence was calculated across the groups and TB predictors were analyzed using modified Poisson regression to compute adjusted prevalence ratio (aPR) with a 95% confidence interval (CI).

Results

The overall prevalence of PTB was 16.7% (309/1853). Of the positive cases, 81.2% (251/309) were in group I (cough ≥2 weeks), 14.2% (44/309) in group II (cough of <2), and 4.5% (14/309) in group III (CXR exempted). PTB predictors were age group of 25-34 [aPR = 2.0 (95% CI 1.3-2.8)], history of weight loss [aPR = 1.2 (95% CI 1.1-1.3)], and TB suggestive CXRs [aPR = 41.1 (95% CI 23.2-72.8)].

Conclusion

The prevalence of confirmed PTB among routine outpatients was high, and this included those with a low duration of cough who can serve as a source of infection. Screening all patients at outpatient departments who passively report any cough irrespective of duration is important to increase TB case finding and reduce TB transmission and mortality.

Detection of Mycobacterium tuberculosis and rifampicin resistance by Xpert® MTB/RIF assay among presumptive tuberculosis cases at Jimma University Medical Center, Southwest Ethiopia

Background

Rapid diagnosis of tuberculosis (TB) and detection of drug resistance are very important for timely and appropriate management of patients. Xpert MTB/RIF assay is approved for use in TB and rifampicin-resistance diagnosis. However, data are limited on the impact of Xpert MTB/RIF assay under routine clinical settings with a heterogeneous group of patients and sample types in Ethiopia.

Methods

A retrospective study was carried out in 2220 presumptive TB cases at Jimma University Medical Center. Data were gathered from the registration logbook using formatted data extraction tools and double entered to epidata version 3.1 and further transported to SPSS version 20 for analysis. Associations were determined using the Chi-square test and P-value <0.05 was considered statistically significant.

Results

Of 2220 cases enrolled, 1665 (75%) were adults and the remaining 555 (25%) were children aged less than 14 years. The majority, 1964 (88.46%), had pulmonary manifestation and 256 (11.54%) had extrapulmonary involvements. The overall, frequency of Mycobacterium tuberculosis (MTB) was 9.3% (206/2220), among this 10.27% (171/1665) and 6.3% (35/555) were adults and children, respectively. M. tuberculosis was detected from 171 (8.75%) of pulmonary patients and 35 (13.28%) of extrapulmonary manifested patients. Out of 206 M. tuberculosis positive cases, 7(3.4%) were rifampicin-resistant: four from pulmonary tuberculosis (PTB) patients and three from EPTB patients. In the Chi-square test, the age group of 15–24 years, previous history of TB, pus/lymph node sample, and being HIV positive were significantly associated with TB positivity by Xpert MTB/RIF (P-value <0.001).

Conclusion

These data suggest that the overall frequency of M. tuberculosis and rifampicin resistance was found to be relatively low compared to the previous reports in Ethiopia. Nevertheless, better diagnostic tools and approaches are still vital to halt the burden of TB and drug-resistant TB in the country.

Detection of Mycobacterium tuberculosis and Rifampicin Resistance Using GeneXpert MTB/RIF Assay at Enat Hospital, Central Ethiopia

Background. Tuberculosis remains to be a public health threat in Ethiopia. However, the use of ill diagnostic methods and the lack of enough epidemiological information in the country contributed to the diagnostic delay and development of anti-TB drug resistance. Therefore, the present study is aimed at assessing the prevalence of pulmonary TB (PTB) and the development of drug resistance using GeneXpert MTB/RIF assay in Merhabete district, Central Ethiopia. Methods. A cross-sectional, health facility-based study was conducted from December 2019 to June 2020. Bacteriological examination and GeneXpert molecular diagnostic methods were used for the detection of M. tuberculosis and rifampicin resistance (RR). Descriptive statistics and logistic regression analysis were used to determine the possible association of risk factors with the occurrence of PTB and RR. $P$ values of <0.05 were considered statistically significant. Results. The overall prevalence rates of PTB and RR M. tuberculosis were 11.2% and 15.8%, respectively. The logistic regression analysis revealed that being in the age group of 49-64 years was significantly associated with the occurrence of TB ( $P=0.01$ ). The odds of HIV-positive and retreatment study participants to be infected by M. tuberculosis were much more than those of HIV-negative and newly treated cases, respectively ( $P<0.05$ ). However, none of the sociodemographic and clinical patient characteristics was significantly associated with the development of RR-TB ( $P>0.05$ ). Conclusion. In the present study, high prevalence rates of PTB and RR M. tuberculosis were observed. The findings, which were attributed to different risk factors, suggested an urgent need for appropriate intervention measures to reduce the transmission of PTB and the development of anti-TB drug resistance in the study area.

Electrochemical Detection of Single-Nucleotide Polymorphism Associated with Rifampicin Resistance in Mycobacterium tuberculosis Using Solid-Phase Primer Elongation with Ferrocene-Linked Redox-Labeled Nucleotides

Here, we report the electrochemical detection of single-point mutations using solid-phase isothermal primer elongation with redox-labeled oligonucleotides. A single-base mutation associated with resistance to rifampicin, an antibiotic commonly used for the treatment of Mycobacterium tuberculosis, was used as a model system to demonstrate a proof-of-concept of the approach. Four 5′-thiolated primers, designed to be complementary with the same fragment of the target sequence and differing only in the last base, addressing the polymorphic site, were self-assembled via chemisorption on individual gold electrodes of an array. Following hybridization with single-stranded DNA, Klenow (exo-) DNA polymerase-mediated primer extension with ferrocene-labeled 2′-deoxyribonucleoside triphosphates (dN^FcTPs) was only observed to proceed at the electrode where there was full complementarity between the surface-tethered probe and the target DNA being interrogated. We tested all four ferrocenylethynyl-linked dNTPs and optimized the ratio of labeled/natural nucleotides to achieve maximum sensitivity. Following a 20 min hybridization step, Klenow (exo-) DNA polymerase-mediated primer elongation at 37 °C for 5 min was optimal for the enzymatic incorporation of a ferrocene-labeled nucleotide, achieving unequivocal electrochemical detection of a single-point mutation in 14 samples of genomic DNA extracted from Mycobacterium tuberculosis strains. The approach is rapid, cost-effective, facile, and can be extended to multiplexed electrochemical single-point mutation genotyping.

The Magnitude of MTB and Rifampicin Resistance MTB Using Xpert-MTB/RIF Assay Among Tuberculosis Suspected Patients in Gedeo Zone, Southern Ethiopia

Background

Tuberculosis (TB) remains a major global health problem causing death among millions of people each year. The new barrier that challenges the control of tuberculosis is the emerging and the increasing number of drug-resistant TB that becomes a world concern. This study aimed to determine the magnitude of rifampicin-resistant Mycobacterium tuberculosis (RR-MTB) among presumptive TB patients attending Dilla University Referral Hospital, Gedeo Zone, Ethiopia.

Methods

A retrospective cross-sectional study was conducted at Dilla University Referral Hospital from January 2014 to December 2020. Sputum results were done using Xpert MTB/RIF assay and other necessary data were collected from the registration logbooks using a standardized data extraction format and analyzed using SPSS version 23 statistical software.

Results

A total of 17,745 presumptive TB patients were included, of which 62.2% were males. The overall prevalence of Mycobacterium tuberculosis (MTB) was 11.8%, of which 5.1% were confirmed to have RR-MTB. Extra-pulmonary TB was reported in 1.5% of the study participants. The highest prevalence of MTB and RR-MTB was recorded in 2017 with a prevalence of 20.1% and 8.5%, respectively. All age groups were significantly associated with a higher prevalence of MTB (p < 0.036). TB patients with a history of previous treatment and HIV positive were significantly associated with MTB (P < 0.021), while RR-MTB was only significantly associated with patients with a history of previous treatment (P < 0.018).

Conclusion

A high magnitude of MTB and RR-MTB was reported among TB patients with HIV and a history of previous treatment. Therefore, coordinated efforts should be applied to the improvement of treatment adherence of known TB cases, and appropriate control and prevention methods to reduce the emergence and increase of MTB and RR-MTB cases.

Differential yield of universal versus selective drug susceptibility testing of patients with tuberculosis in high-burden countries: a systematic review and meta-analysis

Introduction

Although universal drug susceptibility testing (DST) is a component of the End-TB Strategy, over 70% of drug-resistant tuberculosis (DR-TB) cases globally remain undetected. This detection gap reflects difficulties in DST scale-up and substantial heterogeneity in policies and implemented practices. We conducted a systematic review and meta-analysis to assess whether implementation of universal DST yields increased DR-TB detection compared with only selectively testing high-risk groups.

Methods

PubMed, Embase, Global Health, Cochrane Library and Web of Science Core Collection were searched for publications reporting on the differential yield of universal versus selective DST implementation on the proportion of DR-TB, from January 2007 to June 2019. Random-effects meta-analyses were used to calculate respective pooled proportions of DR-TB cases detected; Higgins test and prediction intervals were used to assess between-study heterogeneity. We adapted an existing risk-of-bias assessment tool for prevalence studies.

Results

Of 18 736 unique citations, 101 studies were included in the qualitative synthesis. All studies used WHO-endorsed DST methods, and most (87.1%) involved both high-risk groups and the general population. We found only cross-sectional, observational, non-randomised studies that compared universal with selective DST strategies. Only four studies directly compared the testing approaches in the same study population, with the proportion of DR-TB cases detected ranging from 2.2% (95% CI: 1.4% to 3.2%) to 12.8% (95% CI: 11.4% to 14.3%) with selective testing, versus 4.4% (95% CI: 3.3% to 5.8%) to 9.8% (95% CI: 8.9% to 10.7%) with universal testing. Broad population studies were very heterogeneous. The vast majority (88/101; 87.1%) reported on the results of universal testing. However, while 37 (36.6%)/101 included all presumptive TB cases, an equal number of studies applied sputum-smear as a preselection criterion. A meaningful meta-analysis was not possible.

Conclusion

Given the absence of randomised studies and the paucity of studies comparing strategies head to head, and selection bias in many studies that applied universal testing, our findings have limited generalisability. The lack of evidence reinforces the need for better data to inform policies.

Prevalence of Mycobacterium tuberculosis (Rifampicin-Resistant MTB) and Associated Risk Actors Among Pulmonary Presumptive TB Patients in Eastern Amhara, Ethiopia: 2015-2019

INTRODUCTION

Tuberculosis (TB) is a major health problem, mainly in resource-limited settings. The aim of this study was to determine the prevalence of TB and rifampicin-resistant Mycobacterium tuberculosis (RR-MTB) among presumptive tuberculosis patients using Xpert MTB/RIF assay in Eastern Amhara, Ethiopia.

METHODS

A retrospective cross-sectional study was conducted among presumptive TB patients from three governmental hospitals in Amhara Regional State. Records of sputum sample results using Xpert MTB/RIF assay from January 2015 to December 2019 were investigated from registration books and analyzed using SPSS v.21.

RESULTS

Of the total of 26,656 (24,116 adults and 2540 children) TB presumptive patients included in the study, more than half, 14,624 (54.9%), were males and the median age was 36.87 (interquartile: 25.46-50.85 years). The majority of participants were new cases, 20,273 (76.1%), and with unknown HIV status, 18,981 (71.2%), respectively. MTB prevalence was 11% (95% CI: 9.34-12.08%) in all age groups, and 7.6% (95% CI 6.52-9.04%) among children. Of the MTB confirmed cases, prevalence of RR-MTB was 245 (8.3%) in adults and 14 (7.2%) in children. MTB infection was higher in the age groups of 18-35 years [adjusted odds ratio (AOR) = 2.17; 95% CI: 1.86-2.54, p < 0.001], 36-53 years (AOR = 1.31; 95% CI 1.11-1.54, p < 0.001), those who were relapse cases (AOR = 1.97; 95% CI 1.69-2.27, p < 0.0010), and failure cases (AOR = 4.67; 95% CI 3.36-6.50, p < 0.001). However, the age groups of 54-71 years (AOR = 0.79; 95% CI 0.65-0.95, p = 0.01) and over 71 years (AOR = 0.48; 95% CI 0.35-0.68, p < 0.001) were associated with lower MTB infection. Resistance to rifampicin was higher in the relapsed (AOR = 2.10; 95% CI 1.40-3.03, p < 0.001) and failure cases (AOR = 3.50; 95% CI 1.9-6.61, p < 001).

CONCLUSION

Prevalence of MTB and RR-MTB low. TB infection was higher in adult age groups and those who had previous TB treatment history. Similarly, resistance to rifampicin was higher among the relapsed and failure patients. Appropriate measurements in monitoring of TB treatment could reduce TB and RR-MTB in the study area.

INCIDENCE OF RIFAMPICIN-RESISTANCE PRESUMPTIVE M. TUBERCULOSIS CASES AMONG OUTPATIENTS IN KEBBI STATE, NIGERIA

Background:

The present study determined the incidence of rifampicin resistance M. tuberculosis among outpatients at the General Hospital Yauri, Kebbi State, Nigeria.

Materials and Methods:

The study is a cross-sectional study conducted from February 2018 to October 2019. Sociodemographic data were collected from hospital registration books. Rifampicin resistance M. tuberculosis was detected using GeneXpert Model GX-IV following manufacturers’ instruction. Descriptive statistics and logistic regression were computed using SPSS version 20. The results were presented as odds ratios with associated 95% confidence intervals, and P-value at 0.05.

Result:

Of the 837 samples, 65.8% (551/837) were males, and 34.2% (286/837) females, 11.4% (95/837) HIV-seropositive. M. tuberculosis was detected in 15.5% (130/837), of which 116/130 (89.23%) were males and 14/130 (10.77%) females. M. tuberculosis-HIV coinfection was detected in 9.47% (9/95) of HIV positive. Rifampicin resistance was observed in 1.3% (11/837), 7.7% (10/130) in M. tuberculosis patients and 1.05% (1/94) in HIV seropositive. In logistic regression, the odds ratio for having a rifampicin-resistant M. tuberculosis was 0.49 (0.15-1.54) for > 30 years; taking <30 years as the reference value, 1.02 (1.00-1.03) for male; taking female as the reference value, and 0.78 (0.09-6.15) for HIV positive, taking negative as the reference value.

Conclusion:

This study reported the current incidence rate of rifampicin-resistant M. tuberculosis at the General Hospital Yelwa Yauri, Kebbi State, Nigeria, among presumptive TB patients. Patients diagnosed with rifampicin-resistant M. tuberculosis were predominantly male adults. Thus, frequent screening is vital for surveillance and reduces the risk of transmission and spread of M. tuberculosis infections.

Magnitude of Mycobacterium tuberculosis Infection and Its Resistance to Rifampicin Using Xpert-MTB/RIF Assay Among Presumptive Tuberculosis Patients at Motta General Hospital, Northwest Ethiopia

Background

Mycobacterium Tuberculosis (MTB) and its drug resistance form are the devastating infectious diseases in the world. It is the major cause of morbidity and mortality in low-income countries with Ethiopia carrying a heavy burden. Data on the magnitude of MTB and rifampicin resistance using Xpert- MTB/RIF assay is limited in the study area. Therefore, this study aimed to assess the prevalence of Mycobacterium tuberculosis and rifampicin resistance among presumptive TB patients using GeneXpert at Motta General Hospital, North West Ethiopia.

Methods

A retrospective cross-sectional study was conducted from 1st October to 30 November 2020 among patients tested for GeneXpert at Motta General Hospital, Northwest Ethiopia. Data recorded on GeneXpert test results were collected on laboratory registration book in Microbiology laboratory. Data were analyzed by using the Statistical Package for Social Sciences (SPSS) version 20.

Results

A total of 4109 specimens were tested using the GeneXpert automated system. Of these, the majority 2148 (52.3%) of participants were males and 1961 (47.7%) were females. Similarly, about 1553 (37.8%) were in the age range of 25-44 years followed by 1347 (32.8%) in 45-64 years. Moreover, about 2486 (60.5%) participants were from rural. The overall prevalence of M. tuberculosis was 346 (8.4%) among these, the majority 222 (5.4%) had unknown HIV status, 48 (1.2%) were HIV positive, and 314 (7.6%) was new MTB cases. The overall prevalence of rifampicin resistance was 15 (4.3%) and 8(1.7%) were intermediate. Among rifampicin resistance, 10 (2.9%) were males, 8(2.3%) lived in rural, 9 (2.6%) had unknown HIV status, 13 (3.8%) were new TB patients, and 13 (3.8%) had pulmonary tuberculosis.

Conclusion

The prevalence of M. tuberculosis was 8.4% and relatively higher rate of rifampicin-resistant M. tuberculosis was found.

Frequency of MTB and rifampicin resistance MTB using Xpert-MTB/RIF assay among adult presumptive tuberculosis patients in Tigray, Northern Ethiopia: A cross sectional study

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) continues to be a global health problem. Data on rifampicin resistance MTB using Xpert- MTB/RIF assay in Ethiopia, particularly in the study area is limited. The aim of this study was to determine the frequency of MTB and rifampicin resistant-MTB among presumptive tuberculosis patients in Tigray, Northern Ethiopia.

METHODS

A multicenter retrospective study was conducted among presumptive TB patients from five governmental hospitals and one comprehensive specialized teaching hospital in Tigray regional state. Records of sputum sample results of presumptive MTB patients with Xpert-MTB/RIF assay from January 2016 to December 2019 were investigated. Data extraction tool was used to collect data from registration books and analyzed using SPSS ver.21 statistical software. Statistical significance was set at p-value ≤ 0.05.

RESULTS

Of the 30,935 presumptive adult TB patients who have provided specimens for TB diagnosis from January 2016 to December 2019, 30,300 (98%) had complete data and were included in this study. More than half, 17,471 (57.7%) were males, and the age of the patients ranged from 18-112 years, with a median age of 40.65 (interquartile 29.4-56.5 years). Majority, 28,996 (95.7%) of the participants were treatment naïve, and 23,965 (79.1%) were with unknown HIV status. The overall frequency of MTB was 2,387 (7.9% (95% CI: 7.6-8.2%); of these, 215 (9% (95% CI: 7.9-10.2%) were rifampicin resistant-MTB. Age (18-29 years), HIV positive and previous TB treatment history were significantly associated with high MTB (p < 0.001), whereas gender (being female) was associated with low MTB (p < 0.001). Likewise, rifampicin resistant-MTB was more prevalent among relapse (p < 0.001) and failure cases (p = 0.025); while age group 30-39 years was significantly associated with lower frequency of rifampicin resistant-MTB (p = 0.008).

CONCLUSION

Frequency of MTB among tuberculosis presumptive patients was low; however, the problem of rifampicin resistant-MTB among the tuberculosis confirmed patients was high. The high frequency of MTB and RR-MTB among previously treated and HIV positive patients highlights the need for more efforts in TB treatment and monitoring program in the study area.

Rifampicin-Resistant Mycobacterium tuberculosis Among Patients with Presumptive Tuberculosis in Addis Ababa, Ethiopia

Background

Drug-resistant tuberculosis remains a major public health threat complicating tuberculosis control programs globally. Data on rifampicin resistance (RR), which is a surrogate marker for multidrug resistance, are limited among Ethiopian tuberculosis patients. This study aimed to determine the magnitude of rifampicin-resistant Mycobacterium tuberculosis (RR-MTB) among presumptive tuberculosis patients attending St. Peter Tuberculosis Specialized Hospital, Addis Ababa, Ethiopia.

Patients and Methods

A retrospective cross-sectional study was conducted at St. Peter Tuberculosis Specialized Hospital from January 2016 to December 2018. After checking completeness of the necessary information, data of tuberculosis-presumptive cases who underwent Gene Xpert^® testing were collected from medical records using a data-extraction format prepared for this study purpose. Data were double entered and analyzed using SPSS version 20 statistical software.

Results

A total of 12,685 presumptive tuberculosis patients were included; of whom 54.5% were males and the mean age of the study participants was 40.3±18.7 years. Mycobacterium tuberculosis (MTB) was detected in 1714 participants (13.5%). Of these MTB cases, 169 cases (9.8%) were confirmed to have RR-MTB. Prevalence of MTB was relatively higher among males (15.1%, P=0.78); whereas RR-MTB was higher among females (10.3%, P=0.81). The incidence of MTB and RR-MTB was significantly associated with treatment history (P=0.042 and P=0.025), respectively. HIV infection has significantly associated with incidence of RR-MTB (P=0.032), but not with MTB (P˃0.05). Prevalence of MTB and RR-MTB had a declining trend through time, being 16.7% and 12.9%, 12.8% and 9.1%, and 12.2% and 7.9% in 2016, 2017 and 2018, respectively.

Conclusion

This study showed a decreasing trend of both MTB and RR-MTB from 2016 to 2018 in an MTB, MDR-MTB, and TB/HIV co-infection high-burden setting, Addis Ababa, Ethiopia. Occurrence of MTB and RR-MTB was associated with treatment history. Therefore, improvement in treatment adherence of identified cases would be helpful to prevent emergence or re-emergence of MTB and RR-MTB cases.

Trends of Mycobacterium tuberculosis and rifampicin resistance in Adigrat General Hospital, Eastern zone of Tigrai, North Ethiopia

Background

Tuberculosis is an infectious disease usually caused by Mycobacterium tuberculosis bacteria. The global emergence of mono- or multidrug-resistant tuberculosis and extensively drug-resistant forms of tuberculosis pose a considerable challenge to tuberculosis control programs. There has been no reliable and organized data on trends and drug resistance of Mycobacterium tuberculosis in the study area. Therefore, this study aimed to determine the trends of Mycobacterium tuberculosis and rifampicin resistance in the Adigrat General Hospital, eastern Zone of Tigrai, North Ethiopia.

Methods

A hospital-based retrospective cross-sectional study was conducted at Adigrat General Hospital from January 2015 to 2018.Data was collected retrospectively from the GeneXpert™ TB registration book using a data extraction format. Data was entered into Epi-Info 3.1 and subsequently exported and analyzed using SPSS Version 20.The results were summarized using descriptive statistics, tables, and figures. Bivariate and multi-variant regression analysis was employed to measure the association between dependent and independent variables. P values < 0.05 were considered statistically significant.

Result

A total of 5944 Mycobacterium tuberculosis presumptive patients were included in the study. The majority of the study participants were male (58.1%) with participants’ median age of 40.0 (IQR 26–57) years, the majority were 30–44 years. The overall positive cases of Mycobacterium tuberculosis was 24.3% (1446) with a total of 132 (9.1%) found to be resistant to rifampicin. Of the total confirmed positive cases 8.7% (103/1188) and 11.2% (29/258) were rifampicin resistance of presumptive tuberculosis and presumptive drug resistance tuberculosis patients respectively. Age, the reason for diagnosis, site of presumptive tuberculosis, and/or being HIV infected showed significant association with our dependent variable; however, only age and being HIV infected were associated with rifampicin resistance.

Conclusion

In our study, the overall trends of Mycobacterium tuberculosis and rifampicin resistance were found to be high. Rifampicin resistance is more common in patients with HIV and presumptive drug resistance tuberculosis individuals. Therefore, maximizing early detection of drug-resistant and strengthening tuberculosis infection control activities are recommended to reduce the burden of this contagious and potentially deadly disease.

Rifampicin-Resistant Tuberculosis in a Toddler: A Report of a Rare Paediatric Case in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

The emergence of resistant strains of mycobacterium tuberculosis (TB) to antituberculous drugs has compounded the management of the chronic infection. More than 90% of rifampicin (RIF)-resistant isolates are also isoniazid resistant; hence, rifampicin resistance (RR) is a surrogate marker for multidrug resistant TB (MDR-TB). Although there are limited reports of pediatric RR/MDR-TB in Nigeria, there had not been similar report in our hospital until now. A 2-year-old girl was admitted with 2-month history of fever, cough with dyspnea, and progressive weight loss. There was no known contact with adult who had chronic cough; the toddler and her parents have not been treated for TB in the past. Her chest X-ray showed nodular opacities, while gastric washout for GeneXpert MTB/RIF confirmed RIF-resistant TB. The parents declined screening for TB despite counseling. The patient was subsequently referred to a specialized center for the management of drug-resistant TB, but the parents failed to go for the treatment. Young children are at risk of developing TB disease and MDR/RR-TB, which is more complex to manage than drug-susceptible TB due to longer treatment duration, increased toxicity, as well as poor parental compliance to the demand of treatment.

Rifampicin-resistant Mycobacterium tuberculosis by GeneXpert MTB/RIF and Associated Factors Among Presumptive Pulmonary Tuberculosis Patients in Nepal

Background

Mycobacterium tuberculosis(MTB) remains a major public health problem worldwide, and emergence of drug-resistant TB has become a significant obstacle to effective TB control. However, the rate of MTB and rifampicin resistant-MTB (RR-MTB) in the Nepalese setting has not been studied extensively. Therefore, the present study aims to assess the rate of MTB and RR-MTB and further determine the factors associated with it.

Methods

A retrospective cross-sectional study, among national representative data of 990 consecutive presumptive TB resister of patients subjected to the GeneXpert test that presented to the tuberculosis referral hospital, was conducted over a one year period from February 2018 to January 2019. Significance for the difference for categorical data was performed by Chi-square test and factors associated with MTB and RR-MTB were assessed using binary logistic regression yielding OR with 95%CI.

Results

Of total 990 presumptive tuberculosis analyzed cases, median ages of the patients were 39±19.09 years and two-thirds of the patients were male 653 (66.0%). The estimated prevalence of MTB in presumptive TB patients was 13.8% (95%CI: 11.88%–16.16%), and risk for MTB was significantly associated with previously treated patients: OR: 10.4 (P<0.001). The estimated prevalence of RR-MTB in MTB confirmed patients was 10.2% (4.97%–15.1%). Our study confirmed no association of RR-TB with age, sex, ethnicity, geographical diversity and previous history of treatment failure (P>0.05).

Conclusion

The overall prevalence of MTB and RR-MTB was high in Nepalese study population,  and that being previously treated with anti-TB drug remained significant predictors for MTB; proactive measures are urgently needed to address the challenge of prompt diagnosis, early management and improved monitoring of treatment to limit the emergence drug-resistant MTB strains in the community.

High Prevalence of Rifampicin Resistance Associated with Rural Residence and Very Low Bacillary Load among TB/HIV-Coinfected Patients at the National Tuberculosis Treatment Center in Uganda

Background

Rifampicin resistance (RR) is associated with mortality among tuberculosis (TB) patients coinfected with HIV. We compared the prevalence of RR among TB patients with and without HIV coinfection at the National Tuberculosis Treatment Center (NTTC) in Uganda, a TB/HIV high burdened country. We further determined associations of RR among TB/HIV-coinfected patients.

Methods

In this secondary analysis, we included adult (≥18 years) bacteriologically confirmed TB patients that were enrolled in a cross-sectional study at the NTTC in Uganda between August 2017 and March 2018. TB, RR, and bacillary load were confirmed by the Xpert® MTB/RIF assay in the primary study. A very low bacillary load was defined as a cycle threshold value of >28. We compared the prevalence of RR among TB patients with and without HIV coinfection using Pearson's chi-square test. We performed logistic regression analysis to determine associations of RR among TB/HIV-coinfected patients.

Results

Of the 303 patients, 182 (60.1%) were male, 111 (36.6%) had TB/HIV coinfection, and the median (interquartile range) age was 31 (25-39) years. RR was found among 58 (19.1%) patients. The prevalence of RR was 32.4% (36/111) (95% confidence interval (CI): 24-42) among TB/HIV-coinfected patients compared to 11.5% (22/192) (95% CI: 7–17) among HIV-negative TB patients (p < 0.001). Among TB/HIV-coinfected patients, those with RR were more likely to be rural residents (adjusted odds ratio (aOR): 5.24, 95% CI: 1.51–18.21, p = 0.009) and have a very low bacillary load (aOR: 13.52, 95% CI: 3.15–58.08, p < 0.001).

Conclusion

There was a high prevalence of RR among TB/HIV-coinfected patients. RR was associated with rural residence and having a very low bacillary load among TB/HIV-coinfected patients. The findings highlight a need for universal access to drug susceptibility testing among TB/HIV-coinfected patients, especially in rural settings.

Unknown HIV status and the TB/HIV collaborative control program in Ethiopia: systematic review and meta-analysis

BACKGROUND

Ethiopia has shown significant efforts to address the burden of TB/HIV comorbidity through the TB/HIV collaborative program. However, these diseases are still the highest cause of death in the country. Therefore, this systematic review and meta-analysis evaluated this program by investigating the overall proportion of unknown HIV status among TB patients using published studies in Ethiopia.

METHODS

We conducted a systematic review and meta-analysis of published studies in Ethiopia. We identified the original studies using the databases MEDLINE/PubMed, and Google Scholar. The heterogeneity across studies was assessed using Cochran's Q test and I 2 statistics. The Begg's rank correlation and the Egger weighted regression tests were assessed for the publication bias. We estimated the pooled proportion of unknown HIV status among TB patients using the random-effects model.

RESULTS

Overall, we included 47 studies with 347,896 TB patients eligible for HIV test. The pooled proportion of unknown HIV status among TB patients was 27%(95% CI; 21-34%) and with a substantial heterogeneity (I2 = 99.9%). In the subgroup analysis, the pooled proportion of unknown HIV status was 39% (95% CI; 25-54%) among children and 20% (95% CI; 11-30%) among adults. In the region based analysis, the highest pooled proportion of unknown HIV status was in Gambella, 38% (95% CI; 16-60%) followed by Addis Ababa, 34%(95% CI; 12-55%), Amhara,30%(95% CI; 21-40%),and Oromia, 23%(95% CI; 9-38%). Regarding the study facilities, the pooled proportion of unknown HIV status was 33% (95% CI; 23-43%) in the health centers and 26%(95% CI; 17-35%) in the hospitals. We could not identify the high heterogeneity observed in this review and readers should interpret the results of the pooled proportion analysis with caution.

CONCLUSION

In Ethiopia, about one-third of tuberculosis patients had unknown HIV status. This showed a gap to achieve the currently implemented 90-90-90 HIV/AIDS strategic plan in Ethiopia, by 2020. Therefore, Ethiopia should strengthen TB/HIV collaborative activities to mitigate the double burden of diseases.

Prevalence of Tuberculosis by Automated GeneXpert Rifampicin Assay and Associated Risk Factors Among Presumptive Pulmonary Tuberculosis Patients at Ataye District Hospital, North East Ethiopia

Background

Tuberculosis is a communicable disease that is a major cause of ill health, one of the top 10 causes of death worldwide, and the leading cause of death from a single infectious agent, even ranking above human immuno-deficiency virus (HIV/AIDS).

Objective

To assess the prevalence and associated risk factor of Mycobacterium tuberculosis among pulmonary tuberculosis (PTB) suspects attending at Ataye District Hospital from October 1, 2018, to February 30, 2019.

Methodology

A facility-based cross-sectional study was conducted among 423 presumptive tuberculosis patients at Ataye District Hospital. Sputum was processed by MTB/RIF Xpert assay. Data were entered into EpiData 3.1 software and exported to SPSS version 20.0 (SPSS, Chicago, IL, USA) for analysis. Univariate and multivariate analyses were used to examine the relationship between the dependent and independent variables. Variables that show significance at P-value of 0.3 during univariate analysis were selected for multivariable analysis. A P-value of less than or equal to 0.05 was used to indicate statistical significance.

Results

Out of the total study participants, about 60% were male, and 39% were aged between 18 and 24 years. Of the total 423 PTB suspected patients, 38 (8.98%) of them were identified as having PTB by GeneXpert and 2/38 (5.3%) were resistant to rifampicin and 3/38 (7.89%) patients were co-infected with HIV. Participant age between 18 and 24 years and between 25 and 34 years, weight loss, chest pain, having contact history with confirmed PTB cases, utilization of congested transportation, and a history of imprisonment were significantly associated with the prevalence of PTB.

Conclusion

A considerable prevalence of PTB in the area was observed and the magnitude of MDR-TB was low. PTB is still a public health problem in Ethiopia and there is a need for collaborative prevention and control activities in the study area.

Six Years Trend Analysis of Tuberculosis in Northwestern Tigrai, Ethiopia; 2019: A Retrospective Study

BACKGROUND

Ethiopia is one of the 22 high tuberculosis burden countries. In our country. there are limited published data to show the trend analysis of tuberculosis. Hence, we designed this trend analysis to fill the information gap in our study area. Institutional based retrospective cross-sectional study was employed from 2013 to 2018 to determine the trend analysis of tuberculosis among tuberculosis presumptive clients in Northwestern Tigrai. We have used a standard checklist to extract the data. There were some missing data from the logbooks which are then excluded from the analysis.

RESULTS

A total of 7793 tuberculosis presumptive clients were requested for laboratory diagnosis of which about 7639 results had a valid result for X-pert MTB/Rif assay. The overall detection rate of tuberculosis was found to be 9.9% (756/7639). Of the total tuberculosis cases, 8.7 % (66/756) were rifampicin-resistant. The trend of tuberculosis across the six years was fluctuating with a declining trend in the recent three years. HIV infection and being presumptive to drug resistance were associated with tuberculosis detection.

CONCLUSION

Although there was a cumulative declining trend of tuberculosis within the last six years, prevention and control strategies still need to be improved to achieve the stop tuberculosis strategy. To create a world free of tuberculosis, there should be quality service provision regarding tuberculosis case detection and treatment.

Trend Analysis And Seasonality Of Tuberculosis Among Patients At The Hiwot Fana Specialized University Hospital, Eastern Ethiopia: A Retrospective Study

Purpose

Tuberculosis (TB) is one of the top 10 leading killer diseases in developing countries, particularly in Sub-Saharan Africa, including Ethiopia. Thus, this study aimed to assess the trend analysis and seasonality of TB at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Methods and patients

A hospital-based retrospective study was conducted on 8,001 patients by reviewing all available patients’ data from January 1, 2015 to April 30, 2019, at the Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Socio-demographic characteristics and results of the GeneXpert assay were taken from the registration book. The data were entered into EpiData 3.1 and analyzed by using the statistical Package for Social Sciences (SPSS) version 20.

Results

From a total of 8,001 samples tested using Genexpert, the overall prevalence of Mycobacterium tuberculosis and rifampicin resistance was found to be 1,254 (15.7%) and 53 (4.1%), respectively. A decreasing trend of TB prevalence was observed, and decreased from 19.3% in 2015, 18.6% in 2016, to 18.4% in 2017, 13.5% in 2018 and down to 13.0% in 2019 (P-value<0.001). The maximum number of TB cases were reported during autumn (454, 17.1%) and summer (310, 17.2%) compared to other seasons of all the study period. Being between the ages of 15–29 years (adjusted odds ratio (AOR)=1.7, 95% confidence interval (CI)=1.41–1.98), of male gender (AOR=0.84, 95% CI=0.75–0.96), experiencing a relapse of TB (AOR=0.51, 95% CI=0.35–0.78), and being HIV positive (AOR=0.51, 95% CI=0.3–0.86) were found to be factors associated with high proportion of tuberculosis.

Conclusion

Prevalence of TB has decreased year to year between January 2015 and April 2019. However, a high percentage of patients are still testing positive for TB with different seasonal variations. Thus, understanding and managing TB in seasonal variation, controlling relapse of TB, and screening of all HIV positive patients are recommended steps to reduce the transmission of tuberculosis in Ethiopia.

Monitoring quality indicators for the Xpert MTB/RIF molecular assay in Ethiopia

INTRODUCTION

In Ethiopia, >300 GeneXpert instruments have been deployed for tuberculosis (TB) testing using the Xpert MTB/RIF cartridge. Implementing quality indicators is necessary for monitoring and evaluating the quality of Xpert MTB/RIF diagnostic services.

OBJECTIVE

To assess the use of quality indicators for the Xpert MTB/RIF molecular assay in Ethiopia and to compare the findings with the predefined targets described in the literature.

METHODS

Clinical specimens collected from patients with suspected TB were subjected to Xpert MTB/RIF testing at the National TB Reference Laboratory (NTRL) between January and December 2018. Data were collected from GeneXpert software and Laboratory Information System (LIS) databases. Quality indicators were calculated and analyzed. Bivariate and multivariate analyses were performed using SPSS software version 20 (SPSS Inc., Chicago, Illinois, USA).

RESULTS

Of the 2515 specimens tested, 2274 (90.4%) had successful test results; 18.2% were positive for Mycobacterium tuberculosis (MTB). Among MTB positives (n = 413), 4.8% and 1.0% were rifampicin (RIF)-resistant and RIF-indeterminate cases, respectively. Unsuccessful results were 241 (9.6%); 8.9% of the total number of tests were errors, 0.04% had invalid results and 0.6% 'no result'. The most frequent error was probe check failure (error 5007). Instrument module A4, B2, B3, C3, and D3 (p<0.05) and tester experience (p<0.05) had a statistically significant association with errors in multivariate analysis. Additional 42 MTB cases (9.2% of the total cases) were detected among unsuccessful results by follow-up tests. Sixty-four percent of the initial test results were released within the turnaround time (TAT) ≤24 hours.

CONCLUSION

Most of the quality indicators for the Xpert MTB/RIF molecular assay were maintained within the targets. However, the error rate and TAT were out of the targets. Defective modules and lacking experience were the factors affecting successful test outcomes.