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Home / Public Health Action, Volume 6, Number 2

Open Access Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert® MTB/RIF in Zimbabwe

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Setting: In Zimbabwe, there are concerns about the management of tuberculosis (TB) patients with rifampicin (RMP) resistance diagnosed using Xpert® MTB/RIF.

Objective: To assess linkages between diagnosis and treatment for these patients in Harare and Manicaland provinces in 2014.

Design: A retrospective cohort study.

Results: Of 20 329 Xpert assays conducted, 90% were successful, 11% detected Mycobacterium tuberculosis and 4.5% showed RMP resistance. Of 77 patients with RMP-resistant TB diagnosed by Xpert, 70% had samples sent to the reference laboratory for culture and drug susceptibility testing (CDST); 53% of the samples arrived. In 21% the samples showed M. tuberculosis growth, and in 17% the DST results were recorded, all of which confirmed RMP resistance. Of the 77 patients, 34 (44%) never started treatment for multidrug-resistant (MDR) TB, with documented reasons being death, loss to follow-up and incorrect treatment. Of the 43 patients who started MDR-TB treatment, 12 (71%) in Harare and 17 (65%) in Manicaland started within 2 weeks of diagnosis.

Conclusion: Xpert has been rolled out successfully in two Zimbabwe provinces. However, the process of confirming CDST for Xpert-diagnosed RMP-resistant TB works poorly, and many patients are either delayed or never initiate MDR-TB treatment. These shortfalls must be addressed at the programmatic level.

Keywords: MDR-TB; RMP resistance; SORT IT; Xpert MTB/RIF; culture and drug susceptibility testing; tuberculosis

Document Type: Research Article

Affiliations: 1: International Union Against Tuberculosis and Lung Disease (The Union), Harare, Zimbabwe 2: The Union, Paris, France, National Tuberculosis Programme, Cotonou, Benin 3: The Union, Paris, France, London School of Hygiene & Tropical Medicine, London, UK 4: Ministry of Health and Child Care, Harare, Zimbabwe 5: The Union, Paris, France, Ministry of Health and Child Care, Harare, Zimbabwe 6: The Union, Paris, France 7: Harare City Health Department, Harare, Zimbabwe

Publication date: 21 June 2016

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

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