How has the municipal availability of the GeneXpert®MTB/RIF system affected the detection of drug-resistant tuberculosis in Brazil?

Objective To evaluate the association between the availability of GeneXpert ® MTB/RIF in municipalities and the proportion of people who have access to this diagnostic technology for tuberculosis (TB), as well as the resistance detected by the surveillance system in Brazil. Methods We analyzed 4,998 Brazilian municipalities that reported 432,937 new TB cases between 2015 and 2020. We compared municipalities with and without the availability of GeneXpert ® MTB/RIF regarding the prevalence of effective access to GeneXpert ® MTB/RIF diagnosis and that of detected resistance. Results Municipalities with at least one GeneXpert ® MTB/RIF system had three times (95%CI 2.9-3.0) the access to diagnostic tests and 80.4% (95%CI 70.6%-90.2%) higher detection of resistance, compared to municipalities without this technology. We estimate that there have been 2,110 cases of undetected resistance during this period in the country. Conclusions The availability of GeneXpert ® MTB/RIF system in the municipality increased the sensitivity of the surveillance for detecting TB resistance. Public Health implications It is a priority to strengthen laboratory networks and narrow the gap in access to rapid diagnosis in remote areas to improve the detection and control of drug-resistant tuberculosis. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work had no specific funding. However, FADQ is beneficiary of a fellowship for research productivity from the National Council for Scientific and Technological Development - CNPq, process/contract identification: 312656/2019-0. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All data used in this study are openly accessible and available through the sources listed in the manuscript. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data used in this study are openly accessible and available through the sources listed in the manuscript.