Table 1 Overview of the four diagnostic scenarios to diagnose drug-resistant tuberculosis that are compared in the model
Base case | Deployment of high-throughput MRD assay | ||||
|---|---|---|---|---|---|
Scenario | A. MRD assay following culture | B. Improved analytical sensitivity | C. Improved clinical accuracy | ||
Resistance test for first-line drugs | |||||
Assay | Smear+ | LiPA1 | LiPA1 | rapid MRD | LiPA1 |
Smear- | Xpert | Xpert | rapid MRD | Xpert | |
Specimen | directly on sputum | directly on sputum | directly on sputum | directly on sputum | |
Accuracy: sensitivity; specificity | rifampicin | 99.0; 99.0 % | as Base case | as Base case | 99.8; 99.8 % |
isoniazid | 96.0; 100 % [28] | 99.2; 100 % | |||
(Optimizeda) | |||||
Resistance test for second-line drugs | |||||
Assay | DST on LJ | rapid MRD | rapid MRD | rapid MRD | |
Specimen | cultured isolate | cultured isolate | directly on sputum | cultured isolate | |
Accuracy: sensitivity; specificity | fluoroquinolones | 100 % (definition) | 83.1; 97.7 % | as A | 96.6; 99.5 % |
second-line injectable drugs | 79.5; 95.8 % [9] | 95.9; 99.2 % | |||
(Optimizeda) | |||||
Treatment regimen individualization | |||||
First-line regimen | Standard regimen | Standard regimen | Standard regimen | Standard regimen | |
Second-line regimen | Empirical at treatment initiation, individualized after DST result (2+ months) | Empirical at treatment initiation, individualized after culture + MRD result (2+ weeks) | Individualized from treatment initiation | Empirical at treatment initiation, individualized after culture + MRD result (2+ weeks) | |