Impact of Xpert MTB/RIF implementation in tuberculosis case

Background Since 2014, Brazil has gradually implemented the Xpert MTB/RIF (Xpert) test to enhance early tuberculosis (TB) and drug-resistant (DR-TB) detection and control, yet its nationwide impact remains underexplored. Our study conducts an intervention time-series analysis (ITSA) to evaluate how the Xpert ' s implementation has improved TB and DR-TB detection nationwide. Methods 1,061,776 cases from Brazil ' s National TB Registry (2011 - 2022) were reviewed and ITSA (2011 - 2019) was used to gauge the impact of the Xpert ' s adoption on TB and DR-TB notification. Granger Causality and dynamic regression modelling determined if incorporating Xpert testing as an external regressor enhanced forecasting accuracy for Brazil ' s future TB trends. Findings Xpert implementation resulted in a 9.7% increase in TB noti fi cation and substantial improvements in DR-TB (63.6%) and drug-susceptible TB (92.1%) detection compared to expected noti fi cations if it had not been implemented. Xpert testing counts also presented a time-dependent relationship with DR-TB detection postimplementation, and improved predictions in forecasting models, which depicted a potential increase in TB and DR-TB detection in the next six years. Interpretation This study underscores the critical role of Xpert ' s adoption in boosting TB and DR-TB detection in Brazil, reinforcing the case for its widespread use in disease control. Improvements in prediction accuracy resulting from integrating Xpert data are crucial for allocating resources and reducing the incidence of TB. By acknowledging Xpert's role in both disease control and improving predictions, we advocate for its expanded use and further research into advanced molecular diagnostics for effective TB and DR-TB control. Funding FIOCRUZ. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).