Evaluating the Auto-MODS assay, a novel tool for tuberculosis diagnosis for use in resource-limited settings.
There is an urgent need for simple, rapid, and affordable diagnostic tests for tuberculosis (TB) to combat the great burden of the disease in developing countries. The microscopic observation drug susceptibility assay (MODS) is a promising tool to fill this need, but it is not widely used due to concerns regarding its biosafety and efficiency. This study evaluated the automated MODS (Auto-MODS), which operates on principles similar to those of MODS but with several key modifications, making it an appealing alternative to MODS in resource-limited settings. In the operational setting of Chiang Rai, Thailand, we compared the performance of Auto-MODS with the gold standard liquid culture method in Thailand, mycobacterial growth indicator tube (MGIT) 960 plus the SD Bioline TB Ag MPT64 test, in terms of accuracy and efficiency in differentiating TB and non-TB samples as well as distinguishing TB and multidrug-resistant (MDR) TB samples. Sputum samples from clinically diagnosed TB and non-TB subjects across 17 hospitals in Chiang Rai were consecutively collected from May 2011 to September 2012. A total of 360 samples were available for evaluation, of which 221 (61.4%) were positive and 139 (38.6%) were negative for mycobacterial cultures according to MGIT 960. Of the 221 true-positive samples, Auto-MODS identified 212 as positive and 9 as negative (sensitivity, 95.9%; 95% confidence interval [CI], 92.4% to 98.1%). Of the 139 true-negative samples, Auto-MODS identified 135 as negative and 4 as positive (specificity, 97.1%; 95% CI, 92.8% to 99.2%). The median time to culture positivity was 10 days, with an interquartile range of 8 to 13 days for Auto-MODS. Auto-MODS is an effective and cost-sensitive alternative diagnostic tool for TB diagnosis in resource-limited settings.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Linwei
L
Wang
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Sohaib H
SH
Mohammad
TB/HIV Research Foundation, Chiang Rai, Thailand boonchai@tbhiv.org.
Boonchai
B
Chaiyasirinroje
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Qiaozhi
Q
Li
Supra-National Tuberculosis Reference Laboratory, Bangkok, Thailand.
Somsak
S
Rienthong
Supra-National Tuberculosis Reference Laboratory, Bangkok, Thailand.
Dhanida
D
Rienthong
Chiang Rai Regional Hospital, Chiang Rai, Thailand.
Supalert
S
Nedsuwan
TB/HIV Research Foundation, Chiang Rai, Thailand.
Surakameth
S
Mahasirimongkol
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Yutaka
Y
Yasui
D000328:Adult; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods* / Q000592:standards; D008853:Microscopy; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013785:Thailand; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology*