The Open Microbiology Journal

ISSN: 1874-2858 ― Volume 13, 2019

Use of Xpert MTB/RIF for the Identification of TB and Drug Resistance Among Smear-Negative and Re-Treatment Cases in Rural Areas of Ethiopia

Mesfin Worku1, *, Mulualem Agonafir2, Mubarek A. Yassin2, Mohammed A. Yassin3, Daniel G. Datiko2, Sally Theobald4, Luis E. Cuevas4
1 School of Medical Laboratory Sciences, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
2 REACH Ethiopia, Ethiopia
3 Global Fund to Fight AIDS Tuberculosis and Malaria, Geneva, Switzerland
4 Liverpool School of Tropical Medicine, Liverpool, United Kingdom



Tuberculosis (TB) remains a leading infectious cause of morbidity and mortality worldwide. A key contributor to this burden is poor diagnosis as only 60% of new pulmonary tuberculosis (TB) cases in Africa are ever detected. Therefore, this study aimed to assess the feasibility of Xpert MTB/RIF test implementation in the region, and the performance of the assay to increase case detection on the selected rural health care setting.


To assess the feasibility of Xpert MTB/RIF test implementation in the rural health care setting in Southern Ethiopia.


Two Xpert MTB/RIF machines were brought in 2012 through TB REACH project. It was placed at Yirgalem hospital and at Aletawondo health centre. The instruments were installed after formal training was provided to laboratory technologists for three days. We collected sputum sample from participants who repeatedly had negative smear microscopy and those who had not responded to first-line anti-TB drugs.


Of the total participants tested, 1828 have valid result (MTB-, MTB+/RIF-, MTB+/RIF+, MTB+/RIF Indeterminate). From the participants with valid results, 217 (11.9%) were Xpert-positive of which were 165 (9.0%) RIF-negative, 6 (0.3%) RIF-indeterminate and 46 (2.5%) RIF-positive. Among TB suspects with previous treatment history and positive by Xpert, RIF resistance was detected in 10 (2.2%). From the new TB suspects with positive Xpert, RIF resistance was detected in 29 (2.7%). All cases identified were linked with TB/MDR-TB treatment centers.


Xpert provides an additional tool for the diagnosis of TB and drug resistance, with almost 12% of new and retreatment cases obtaining information that is useful for clinical management. To enhance its efficient utilisation, operational challenges should be minimized particularly in relation to availing robust alternative power source.

Keyword: Xpert, Tuberculosis, SNNPR, Operational challenges, Negative smear microscopy, TB/MDR-TB.

Article Information

Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 188
Last Page: 192
Publisher Id: TOMICROJ-13-188
DOI: 10.2174/1874285801913010188

Article History:

Received Date: 23/01/2019
Revision Received Date: 16/05/2019
Acceptance Date: 22/05/2019
Electronic publication date: 30/06/2019
Collection year: 2019

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© 2019 Worku et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at theSchool of Medical Laboratory Sciences, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia; Tel: +251911904261; Emails:


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