title: Microscopic observation drug susceptibility assay for the diagnosis of TB and MDR-TB in HIV-infected patients: a systematic review and meta-analysis.
abstract: The objective of the present study was to assess the diagnostic accuracy of the microscopic observation drug susceptibility (MODS) assay for tuberculosis (TB) diagnosis in HIV-infected patients. MEDLINE, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials, African Index Medicus, ResearchGate, SciELO, and the abstracts of the main conferences on infectious diseases and tropical medicine were searched, and other sources investigated. Only studies including HIV-infected patients evaluating MODS for the diagnosis of TB and using culture-based diagnostic tests as a gold standard were analysed. Summary sensitivity and specificity were calculated with a bivariate model. 3259 citations were found, 29 were selected for full-text review and 10 studies including 3075 samples were finally analysed. Overall diagnostic accuracy of MODS for the diagnosis of TB was a sensitivity of 88.3% (95% CI 86.18-90.2%) and specificity 98.2% (95% CI 97.75-98.55%). For multidrug-resistant (MDR)-TB, sensitivity was 89% (95% CI 66.07-97%) and specificity was 100% (95 CI 94.81-100%). For smear-negative pulmonary TB, a sensitivity of 88.2% (95% CI 86.1-89.9%) and specificity of 98.2% (95% CI 96.8-98.9%) were found. Costs varied between USD 0.72 and 7.31 per sample. Mean time to positivity was 8.24 days. MODS was found to have a good accuracy for the diagnosis of TB and MDR-TB in HIV-infected patients with low cost and fast results.
authors.affiliation: SolidarMed Mozambique, Pemba, Mozambique University of Barcelona, Dept of Public Health, Barcelona, Spain wikman.philip@gmail.com.
authors.forename: Philip
authors.initials: P
authors.lastname: Wikman-Jorgensen
authors.affiliation: SolidarMed Mozambique, Pemba, Mozambique.
authors.forename: Jara
authors.initials: J
authors.lastname: Llenas-García
authors.affiliation: SolidarMed Switzerland, Lucerne, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Hobbins
authors.affiliation: SolidarMed Switzerland, Lucerne, Switzerland.
authors.forename: Jochen
authors.initials: J
authors.lastname: Ehmer
authors.affiliation: University of Barcelona, Dept of Public Health, Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Abellana
authors.affiliation: University of Barcelona, Dept of Public Health, Barcelona, Spain.
authors.forename: Alessandra Queiroga
authors.initials: AQ
authors.lastname: Gonçalves
authors.affiliation: University of Barcelona, Dept of Public Health, Barcelona, Spain Pediathrics department, CAP Valldoreix, Research Unit, Mútua Terrassa Foundation, Mútua Terrassa University Hospital, Terrassa, Spain.
authors.forename: Tomàs Maria
authors.initials: TM
authors.lastname: Pérez-Porcuna
authors.affiliation: University of Barcelona, Dept of Public Health, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ascaso
mesh_terms: D015658:HIV Infections / Q000150:complications; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D012680:Sensitivity and Specificity; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000382:microbiology*