{"doi":"10.3389/fmed.2022.909198","title":"Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia","abstract":"Introduction Tuberculosis (TB) is a major public health concern in Indonesia, where the incidence was 301 cases per 100,000 inhabitants in 2020 and the prevalence of multi-drug resistant (MDR) TB is increasing. Diagnostic testing approaches vary across Indonesia due to resource limitations. Acid-fast bacilli (AFB) smear is widely used, though Xpert MTB/RIF has been the preferred assay for detecting TB and rifampicin resistance since 2012 due to higher sensitivity and ability to rapidly identify rifampicin resistance. However, <1,000 Xpert instruments were available in Indonesia as of 2020 and the Xpert supply chain has suffered interruptions. Methods We compared the performance of Xpert MTB/RIF and AFB smear to facilitate optimization of TB case identification. We analyzed baseline data from a cohort study of adults with pulmonary TB conducted at seven hospitals across Indonesia. We evaluated sensitivity and specificity of AFB smear and Xpert MTB/RIF using Mycobacterium tuberculosis (Mtb) culture as the gold standard, factors associated with assay results, and consistency of Xpert MTB/RIF with drug susceptibility test (DST) in detecting rifampicin resistance. Results Sensitivity of AFB smear was significantly lower than Xpert MTB/RIF (86.2 vs. 97.4%, p -value <0.001), but specificity was significantly better (86.7 vs. 73.3%, p -value <0.001). Performance varied by hospital. Positivity rate for AFB smear and Mtb culture was higher in subjects with pulmonary cavities and in morning sputum samples. Consistency of Xpert MTB/RIF with DST was lower in those with rifampicin- sensitive TB by DST. Discussion Additional evaluation using sputa from primary and secondary Indonesian health centers will increase the generalizability of the assessment of AFB smear and Xpert MTB/RIF performance, and better inform health policy. Clinical trial registration [ https://clinicaltrials.gov/ ], identifier [NCT027 58236].","journal":"Frontiers in Medicine","year":2023,"id":335868,"datarank":0.7411220751616462,"base_score":2.995732273553991,"endowment":2.995732273553991,"self_citation_contribution":0.4493598410330987,"citation_network_contribution":0.2917622341285475,"self_endowment_contribution":0.4493598410330987,"citer_contribution":0.2917622341285475,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":18,"citers_with_citation_signal":9,"citers_with_endowment":9,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9503,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT00000027"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1065855,"name":"Erlina Burhan","orcid":"0000-0002-8115-8293","position":1,"is_corresponding":false},{"id":1065856,"name":"Eko Budi Koendhori","orcid":"0000-0002-4412-0755","position":2,"is_corresponding":false},{"id":1066317,"name":"Desvita Sari","orcid":null,"position":3,"is_corresponding":false},{"id":1065857,"name":"Budi Haryanto","orcid":"0000-0001-5208-5980","position":4,"is_corresponding":false},{"id":1065858,"name":"Titik Nuryastuti","orcid":"0000-0003-3463-4733","position":5,"is_corresponding":false},{"id":1066318,"name":"A. A. A. Yuli Gayatri","orcid":null,"position":6,"is_corresponding":false},{"id":1066319,"name":"Uleng Bahrun","orcid":null,"position":7,"is_corresponding":false},{"id":1065859,"name":"R. Lia Kusumawati","orcid":"0000-0002-0459-1026","position":8,"is_corresponding":false},{"id":946872,"name":"Retna Indah Sugiyono","orcid":null,"position":9,"is_corresponding":false},{"id":961212,"name":"Nugroho Harry Susanto","orcid":"0000-0001-5914-3194","position":10,"is_corresponding":false},{"id":961211,"name":"Aly Diana","orcid":"0000-0002-9394-5235","position":11,"is_corresponding":false},{"id":321448,"name":"Herman Kosasih","orcid":"0000-0003-1095-3422","position":12,"is_corresponding":false},{"id":718956,"name":"Adhella Menur Naysilla","orcid":"0009-0007-4257-3113","position":13,"is_corresponding":false},{"id":321446,"name":"Dewi Lokida","orcid":"0000-0003-2476-4139","position":14,"is_corresponding":false},{"id":321454,"name":"Aaron Neal","orcid":"0000-0001-7674-0038","position":15,"is_corresponding":false},{"id":461689,"name":"Sophia Siddiqui","orcid":"0000-0002-1421-0194","position":16,"is_corresponding":false},{"id":321453,"name":"Chuen‐Yen Lau","orcid":"0000-0002-4337-8885","position":17,"is_corresponding":false},{"id":321455,"name":"Muhammad Karyana","orcid":"0000-0002-7785-5731","position":18,"is_corresponding":false},{"id":1065854,"name":"Anis Karuniawati","orcid":"0000-0002-9882-2488","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-19T01:10:02.777338Z","pmid":"36743681","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}