The Role of GeneXpert® for Tuberculosis Diagnostics in Brazil: An Examination from a Historical and Epidemiological Perspective

Tirça Naiara da Silva Iúdice; Marília Lima da Conceição; Artemir Coelho de Brito; Nicole Menezes de Souza; Cristal Ribeiro Mesquita; Ricardo José de Paula Souza E Guimarães; Ismari Perini Furlaneto; Alessandra de Souza Saboia; Maria Cristina da Silva Lourenço; Karla Valéria Batista Lima; Emilyn Costa Conceição

doi:10.3390/tropicalmed8110483

The Role of GeneXpert^® for Tuberculosis Diagnostics in Brazil: An Examination from a Historical and Epidemiological Perspective

Trop Med Infect Dis. 2023 Oct 26;8(11):483. doi: 10.3390/tropicalmed8110483.

Authors

Affiliations

¹ Programa de Pós-Graduação Biologia Parasitária na Amazônia, Universidade do Estado do Pará, Belém-Pará 66087-670, PA, Brazil.
² Seção de Bacteriologia e Micologia, Instituto Evandro Chagas, Ananindeua 67030-000, PA, Brazil.
³ Coordenação-Geral de Vigilância da Tuberculose, Micoses Endêmicas e Micobactérias Não Tuberculosas-CGTM, Ministério da Saúde, Brasília 70000-000, DF, Brazil.
⁴ Laboratório de Geoprocessamento, Instituto Evandro Chagas, Ananindeua 67030-000, PA, Brazil.
⁵ Curso de Medicina, Centro Universitário do Estado do Pará, Belém 66087-662, PA, Brazil.
⁶ Laboratório de Bacteriologia e Bioensaios em Micobactérias, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro 21040-360, RJ, Brazil.
⁷ Pós-Graduação em Pesquisa Clínica e Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro 67030-000, RJ, Brazil.
⁸ Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa.

Abstract

The rapid molecular test (RMT) performed on the GeneXpert^® system is widely used as a control strategy and surveillance technique for tuberculosis (TB). In the region of the Americas, TB incidence is slowly increasing owing to an upward trend in Brazil, which is among the high TB-burden countries (HBCs), ranking in the 19th position. In this context, we aimed to (i) describe the implementation and history of RMT-TB (Xpert^® MTB/RIF and Xpert^® MTB/RIF Ultra) in Brazil; (ii) to evaluate the national RMT laboratory distribution, TB, and resistance to RIF detection by RMT; and (iii) to correlate these data with Brazilian TB incidence. The quantitative data of Xpert^® MTB/RIF and Xpert^® MTB/RIF Ultra assays performed in the pulmonary TB investigation from 2014 to 2020 were provided by the Brazilian Ministry of Health. A spatial visualization using ArcGIS software was performed. The Southeast region constituted about half of the RMT laboratories-from 39.4% to 45.9% of the total value over the five regions. Regarding the federal units, the São Paulo state alone represented from 20.2% to 34.1% (5.0 to 8.5 times the value) of RMT laboratories over the years observed. There were significant differences (p < 0.0001) in the frequency of RMT laboratories between all years of the historical series. There was an unequal distribution of RMT laboratories between Brazilian regions and federal units. This alerts us for the surveillance of rapid molecular detection of TB in different parts of the country, with the possibility of improving the distribution of tests in areas of higher incidence in order to achieve the level of disease control recommended by national and worldwide authorities.

Keywords: Brazil; Xpert MTB/RIF; Xpert MTB/RIF Ultra; rapid molecular test; tuberculosis.

Grants and funding

The support for this project came from the CAPES Foundation (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), which operates under the Brazilian Ministry of Education and was granted with the number 1660892.