*[1]Irek, E. O., [2]Isinkaye, A. O., and [3]Orojo, J. A.
1Department of Medical Microbiology and Parasitology, Afe Babalola University/Afe Babalola University Multi-System Hospital, Ado-Ekiti, Nigeria
2Department of Community Medicine, Federal Teaching Hospital, Ido, Ekiti, Nigeria
3Tuberculosis Leprosy and Buruli Control Programme, Primary Health Care Development Agency, Ado-Ekiti, Nigeria
*Correspondence to: dj1irek@yahoo.com; +2348136833485; ORCID: 0000-0001-6363-6645
Abstract:
Background: Drug-resistant tuberculosis (DR-TB) poses a significant challenge to global TB control efforts, particularly in low- and middle-income countries (LMICs) where diagnostic resources are limited, thereby widening treatment gap. This has increased morbidity and mortality due to TB in Sub-Saharan Africa. We sought to evaluate the role of clinical diagnosis in identifying DR-TB in pulmonary TB cases missed by the sputum GeneXpert MTB/RIF assay in Ekiti State, Nigeria.
Methodology: A secondary data analysis was conducted using the 2024 National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP) register in Ekiti State. Data on demographics, diagnostic methods, and resistance patterns were extracted and analyzed using descriptive statistics.
Results: Among 28 DR-TB cases identified, GeneXpert MTB/RIF assay detected only 53.6% (n=15), missing 46.4% (n=13) which were subsequently identified through clinical suspicion followed by Line Probe Assay. MDR-TB accounted for 46.4% (n=13), rifampicin mono-resistance for 39.3% (n=11), and isoniazid mono-resistance for 14.3% (n=4). Two cases of pre-XDR TB were observed among people living with HIV, both of whom had false-negative GeneXpert results. The average diagnostic delay from GeneXpert testing to LPA-based diagnosis was 16 days.
Conclusion: Clinical evaluation is critical in bridging diagnostic gaps created by false-negative GeneXpert results, ensuring timely identification and treatment of DR-TB.
Keywords: Diagnostic gaps, Nigeria, GeneXpert, Tuberculosis
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