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Implementing universal rifampicin testing for TB in Pakistan: results and implications for the TB response

S Tahseen1, M R Siddiqui2, F M Khanzada1

  • 1National TB Reference Laboratory, National TB Control Programme, Islamabad.

The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease
|September 11, 2020
PubMed

Insights

Comprehensive Xpert MTB/RIF and rifampicin testing in Pakistan showed increased tuberculosis case confirmation. Rifampicin resistance significantly declined in previously treated adult pulmonary TB patients.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Molecular Diagnostics

Background:

  • Tuberculosis (TB) remains a significant global health challenge, necessitating improved diagnostic strategies.
  • Pakistan faces a high burden of TB, requiring efficient and accurate testing methods.
  • The implementation of Xpert MTB/RIF and universal rifampicin testing aims to enhance TB diagnosis and resistance surveillance.

Purpose of the Study:

  • To evaluate the outcomes of integrating Xpert MTB/RIF and universal rifampicin testing in a specialized chest hospital in Pakistan.
  • To assess the impact of these diagnostic advancements on TB case confirmation and rifampicin resistance detection.

Main Methods:

  • A 3-year retrospective review of registered TB patient records.
  • Analysis of Xpert MTB/RIF and rifampicin resistance testing data from 11,744 TB patients.
  • Comparison of testing and confirmation rates before and after the implementation of comprehensive testing strategies.

Main Results:

  • Xpert MTB/RIF use surged in adult pulmonary TB patients from <1% to 81.6% between 2016 and 2018.
  • Bacteriologically confirmed pulmonary TB in adults increased significantly from 64% to 77.3% (P < 0.001).
  • A significant decline in rifampicin resistance was observed in previously treated adult pulmonary TB patients (15.4% to 8.6%).

Conclusions:

  • Universal rifampicin testing is feasible and effective for adult pulmonary TB patients.
  • The integrated approach led to improved TB diagnosis and a notable reduction in rifampicin resistance among previously treated individuals.

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