title: Initial experience with GeneXpert MTB/RIF assay in the Arkansas Tuberculosis Control Program.
abstract: BACKGROUND
  Mycobacterium tuberculosis remains one of the most significant causes of death from an infectious agent. Rapid and accurate diagnosis of pulmonary and extra-pulmonary tuberculosis (TB) is still a great challenge. The GeneXpert MTB/RIF assay is a novel integrated diagnostic system for the diagnosis of tuberculosis and rapid detection of Rifampin (RIF) resistance in clinical specimens. In 2012, the Arkansas Tuberculosis Control Program introduced GeneXpert MTB/RIF assay to replace the labour-intensive Mycobacterium Tuberculosis Direct (MTD) assay.
  
  
  OBJECTIVE
  To rapidly diagnose TB within two hours and to simultaneously detect RIF resistance.
  
  
  OBJECTIVE
  Describe the procedure used to introduce GeneXpert MTB/RIF assay in the Arkansas Tuberculosis Control Program.Characterise the current gap in rapid M. tuberculosis diagnosis in Arkansas.Assess factors that predict acid fast bacilli (AFB) smearnegative but culture-positive cases in Arkansas.Illustrate, with two case reports, the role of GeneXpert MTB/RIF assay in reduction of time to confirmation of M. tuberculosis diagnosis in the first year of implementation.
  
  
  METHODS
  Between June 2012 and June 2013, all AFB sputum smearpositive cases and any others, on request by the physician, had GeneXpert MTB/RIF assay performed as well as traditional M. tuberculosis culture and susceptibilities using Mycobacteria Growth Indicator Tube (MGIT) 960 and Löwenstein-Jensen (LJ) slants. Surveillance data for January 2009-June 2013 was analysed to characterise sputum smear-negative but culture-positive cases.
  
  
  RESULTS
  Seventy-one TB cases were reported from June 2012- June 2013. GeneXpert MTB/RIF assay identified all culture-positive cases as well as three cases that were negative on culture. Also, this rapid assay identified all six smear-negative but M. tuberculosis culture-positive cases; two of these cases are described as case reports.
  
  
  CONCLUSIONS
  GeneXpert MTB/RIF assay has made rapid TB diagnosis possible, with tremendous potential in determining isolation of TB suspects on one hand, and quickly ruling out TB whenever suspected.
authors.affiliation: Arkansas Department of Health ; University of Arkansas for Medical Sciences.
authors.forename: Naveen
authors.initials: N
authors.lastname: Patil
authors.affiliation: University of Arkansas for Medical Sciences.
authors.forename: Hamida
authors.initials: H
authors.lastname: Saba
authors.affiliation: Arkansas Department of Health.
authors.forename: Asween
authors.initials: A
authors.lastname: Marco
authors.affiliation: University of Arkansas for Medical Sciences.
authors.forename: Rohan
authors.initials: R
authors.lastname: Samant
authors.affiliation: Arkansas Department of Health ; University of Arkansas for Medical Sciences.
authors.forename: Leonard
authors.initials: L
authors.lastname: Mukasa
keywords: AFB; GeneXpert MTB/RIF assay; Tuberculosis