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Public Health Action. 2019 Sep 21;9(Suppl 1):S12-S18. doi: 10.5588/pha.19.0005.

Drug-resistant tuberculosis diagnosis since Xpert® MTB/RIF introduction in Papua New Guinea, 2012-2017.

Author information

Central Public Health Laboratory, Port Moresby, Papua New Guinea (PNG).
Health and HIV Implementation Services Provider, Port Moresby, PNG.
Queensland Mycobacterium Reference Laboratory, Pathology Queensland Central Laboratory at Royal Brisbane Hospital, Brisbane, Queensland, Australia.
Papua New Guinea National TB Programme, Port Moresby, PNG.
Burnet Institute, Melbourne, Victoria, Australia.
Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia.
Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, PNG.


in English, French, Spanish


Xpert® MTB/RIF was introduced in Papua New Guinea in 2012 for the diagnosis of tuberculosis (TB) and of rifampicin-resistant TB (RR-TB), a marker of multi-drug-resistant TB (MDR-TB).


To assess the concordance of Xpert with phenotypic drug susceptibility testing (DST) performed at the supranational reference laboratory and to describe the patterns of drug-resistant TB observed.


This was a retrospective descriptive study of laboratory data collected from April 2012 to December 2017.


In 69 months, 1408 specimens with Xpert results were sent for mycobacterial culture and DST; Mycobacterium tuberculosis was cultured from 63% (884/1408) and DST was completed in 99.4%. The concordance between Xpert and culture for M. tuberculosis detection was 98.6%. Of 760 RR-TB cases, 98.7% were detected using Xpert; 98.5% of 620 MDR-TB cases were identified using phenotypic DST. Phenotypic resistance to second-line drugs was detected in 59.4% (522/879) of specimens tested, including 29 with fluoroquinolone resistance; the majority were from the National Capital District and Daru Island.


The high concordance between phenotypic DST and Xpert in identifying RR-TB cases supports the scale-up of initial Xpert testing in settings with high rates of drug resistance. However, rapid DST in addition to the detection of RR-TB is required.


Papua New Guinea; Xpert® MTB/RIF; drug susceptibility testing; multidrug-resistant tuberculosis

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