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Int J Mycobacteriol. 2018 Oct-Dec;7(4):299-309. doi: 10.4103/ijmy.ijmy_135_18.

Meta-narrative review of molecular methods for diagnosis and monitoring of multidrug-resistant tuberculosis treatment in adults.

Author information

1
Kibong'oto Infectious Diseases Hospital, Sanya Juu, Siha, Kilimanjaro; Department of Global Health and Biomedical Sciences, School of Life Science and Bioengineering, Nelson Mandela-African Institution for Science and Technology, Arusha, Tanzania.
2
Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
3
Department of Global Health and Biomedical Sciences, School of Life Science and Bioengineering, Nelson Mandela-African Institution for Science and Technology, Arusha, Tanzania.
4
Muhimbili Centre, National Institute for Medical Research, Dar es Salaam, Tanzania.
5
Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.

Abstract

Early and accurate diagnosis and rigorous clinical and microbiological monitoring of multidrug-resistant tuberculosis (MDR-TB) treatment can curb morbidity and mortality. While others are still under evaluation, the World Health Organization has recommended few novel molecular methods for MDR-TB diagnosis only. We present current molecular methods for diagnosis and monitoring of MDR-TB treatment in TB-endemic settings. A systematic meta-narrative review was conducted according to the RAMESES recommendations. Electronic databases were searched for relevant articles published in English language from January 2013 to June 2018. Based on predefined criteria, two independent reviewers extracted the key messages from relevant articles. Disagreement between them was resolved through discussion and the involvement of a third reviewer, if needed. Key messages were synthesized to create the meta-narratives for method's accuracy, drug-susceptibility capability, and laboratory infrastructure required. We included 33 articles out of 1213 records retrieved, of which 16 (48%) and 12 (36%) were conducted in high- and low-TB-endemic settings, respectively. Xpert® MTB/RIF, GenoType MTBDRplus, GenoType MTBDRsl, FlouroType™ MTBDR, TB TaqMan® array card, and DNA sequencers can accurately guide effective treatment regimens. Molecular bacterial load assay quantifies mycobactericidal impact of these regimens. Although they present inherent advantages compared to the current standard of care, they carry important limitations to implementation and/or scale-up. Therefore, considerable effort must now be directed to implementation and health systems research to maximize these forecasted benefits for individual patient's health outcomes.

KEYWORDS:

Anti-tuberculosis therapy; diagnosis; drug-resistant tuberculosis; molecular methods; monitoring

PMID:
30531026
DOI:
10.4103/ijmy.ijmy_135_18
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