Dynamic modelling of improved diagnostic testing for drug-resistant tuberculosis in high burden settings.

IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES BMC Infectious Diseases Pub Date : 2024-11-05 DOI:10.1186/s12879-024-10027-6
Marya Getchell, John Pastor Ansah, Dodge Lim, Ramon Basilio, Francis Tablizo, Surakameth Mahasirimongkol, Waritta Sawaengdee, David Matchar
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Abstract

Background: Limited diagnostic testing for drug-resistant TB (DR-TB) may lead to high rates of misdiagnosis and undertreatment. Current diagnostic tests focus only on detection of rifampicin-resistant TB (RR-TB). This study aims to determine the impact of improved diagnostic testing for a wider range of drug resistance on DR-TB outcomes in high-burden TB settings, using the Philippines and Thailand as case studies.

Methods: A dynamic compartmental model was designed to simulate population level TB transmission, accounting for acquired drug resistance from treatment failure of drug susceptible TB. Three scenarios were analyzed: (1) Use of GeneXpert MTB/RIF on all presumptive TB cases (Status Quo); (2) GeneXpert MTB/RIF + GeneXpert XDR, (3) GeneXpert MTB/RIF + targeted Next Generation Sequencing (tNGS). Scenarios were modelled over a 10-year period, from 2025 to 2034.

Results: Compared to the status quo, Scenario 2 results in a fourfold increase in annual DR-TB cases diagnosed in the Philippines and a fivefold increase in Thailand. DR-TB treatment failure decreases by 20% in the Philippines and 23% in Thailand. Scenario 3 further increases DR-TB case detection, reducing DR-TB treatment failure by 26% in the Philippines and 29% in Thailand. Reductions in DR-TB incidence and mortality ranged from 3 to 6%.

Conclusion: The use of GeneXpert XDR or tNGS as an additional diagnostic test for DR-TB significantly improves DR-TB case detection and reduces treatment failure, supporting their consideration for use in high burden settings. These findings highlight the importance of detecting a wider range of TB resistance in addition to RR-TB, the potential impact these improved diagnostic tests can have on DR-TB outcomes, and the need for additional research on cost-effectiveness of these interventions.

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在高负担环境中改进耐药结核病诊断检测的动态模型。
背景:耐药性结核病(DR-TB)诊断检测的局限性可能会导致高误诊率和治疗不足。目前的诊断检测仅侧重于检测耐利福平肺结核(RR-TB)。本研究旨在以菲律宾和泰国为案例,确定在结核病高负担地区,改进诊断检测以检测更广泛的耐药性对 DR-TB 治疗结果的影响:方法:设计了一个动态分区模型来模拟人群水平的结核病传播,并考虑到易感结核病治疗失败后获得的耐药性。分析了三种情况:(1) 对所有推定肺结核病例使用 GeneXpert MTB/RIF(现状);(2) GeneXpert MTB/RIF + GeneXpert XDR;(3) GeneXpert MTB/RIF + 目标下一代测序 (tNGS)。方案模拟期为 10 年,从 2025 年到 2034 年:结果:与现状相比,方案 2 导致菲律宾每年确诊的 DR-TB 病例增加四倍,泰国增加五倍。菲律宾的 DR-TB 治疗失败率下降了 20%,泰国下降了 23%。方案 3 进一步提高了 DR-TB 病例的发现率,使菲律宾的 DR-TB 治疗失败率降低了 26%,泰国降低了 29%。DR-TB 发病率和死亡率的降幅在 3% 到 6% 之间:结论:使用 GeneXpert XDR 或 tNGS 作为 DR-TB 的附加诊断检测可显著提高 DR-TB 病例的检出率并减少治疗失败,因此可考虑在高负担环境中使用。这些发现强调了除 RR-TB 外检测更广泛的结核病耐药性的重要性、这些改进的诊断检测对 DR-TB 治疗结果的潜在影响,以及对这些干预措施的成本效益进行更多研究的必要性。
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来源期刊
BMC Infectious Diseases
BMC Infectious Diseases 医学-传染病学
CiteScore
6.50
自引率
0.00%
发文量
860
审稿时长
3.3 months
期刊介绍: BMC Infectious Diseases is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology.
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