
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
Public Health Impact of the Genexpert MTB/RIF Implementation in Tuberculosis Control in Brazil: A Nationwide Intervention Time-Series Analysis
30 Pages Posted: 4 Dec 2023
More...Abstract
Background: Adequate laboratory diagnostic testing is essential for management of drug-resistant tuberculosis (DR-TB). Since 2014, Brazil has gradually implemented the GeneXpert MTB/RIF (GeneXpert) test to enhance early tuberculosis (TB) and DR-TB detection. Nonetheless, the nationwide public health impact of this implementation remains underexplored.
Methods: 1,088,544 cases from Brazil's National TB Registry (2011-2022) were evaluated to assesses the influence of the GeneXpert adoption on TB notification, including DR-TB and drug-susceptible TB (DS-TB) screening. Intervention time-series analysis gauged the impact of GeneXpert implementation on case detection, while Granger Causality assessed its predictive power on future disease trends. Dynamic regression modelling determined if incorporating GeneXpert testing as an external regressor enhanced forecasting accuracy for Brazil’s future TB trends. Geographical distribution in testing and notification rates were also examined.
Findings: GeneXpert implementation resulted in a 9·7% increase in TB notification and substantial improvements in DR-TB (63·6%) and DS-TB (92·1%) detection compared to counterfactual measures. Cross-correlation and Granger Causality validated the time-dependent relationship and predictive power of GeneXpert testing on DR-TB control. Dynamic regression analysis showed GeneXpert’s utility in enhancing forecasts of disease burden, projecting a possible scenario of increase in TB and DR-TB cases over the next 6 years. However, regional disparities were evident, with the Southeast and South regions reporting higher testing coverage.
Interpretation: Our study underscores the critical role of the GeneXpert adoption in boosting TB and DR-TB detection in Brazil, beneficiating disease management and offering insights for effective public health measures worldwide. Improvements in prediction accuracy caused by integrating GeneXpert data into dynamic regression models highlight the importance of using external predictors in epidemiological forecasting. By acknowledging the GeneXpert’s role in both disease management and improving predictions, we advocate for its expanded use and further research into advanced molecular diagnostics for effective TB and DR-TB control worldwide.
Funding: Oswaldo Cruz Foundation Intramural Research Program
Declaration of Interest: None to declare.
Ethical Approval: These data were pre-processed by the Brazilian MoH to check for duplicates, completeness, and consistency, following the guidelines of Resolution Number 466/12 on Research Ethics by the National Health Council, Brazil.
Keywords: GeneXpert MTB/RIF, intervention time-series, drug-resistant tuberculosis, laboratory diagnostics, public health measures
Suggested Citation: Suggested Citation