Assessment of Performance Current Diagnostic Tools of Drug-Resistant Tuberculosis: A Comprehensive Meta-Analysis

The main target of this research is to determine the best diagnostic tool for MDR TB which is appropriate to use in daily practice in Indonesia. So far, based on Indonesia's TB Guideline, the diagnostic for MDR TB is phenotypic and genotypic method using Xpert MTB/RIF and MTBDRplus. There are various new diagnostic tools, such as Abbott RealTime, Microscopic-Observation Drug Susceptibility (MODS), pncA-Seq, and Wayne test. The specific target for this research including meta-analysis comparison of the sensitivity which provides information about how well the test can catch true positive cases and specificity which provides information about how well the test can exclude individuals who are actually negative; AUC values; PPV, NPV, PLR, NLR, DOR, and Accuracy diagnostic tools for Rifampicin resistant TB, Isoniazid, Pyrazinamide, and multidrug resistant TB. MTBDRplus superior than Xpert MTB/RIF with sensitivity 97% (95% CI: 96-98, I2: 66,92%) and specificity 97% (95% CI: 96-98, I2: 79,06%); Superior than Abott RealTime with sensitivity 94% (95% CI: 92-96, I2: 82,18%) and specificity 97% (95% CI: 95-99, I2: 93,00%); and excellent to detect MDR TB with sensitivity 96% (95% CI: 93-98, I2: 62,02%) and specificity 98% (95% CI: 95-99, I2: 95,75%). The best Pyrazinamide resistance tool is pncA-Seq with sensitivity 94% (95% CI: 79-98, I2: 95,65%) and specificity 99% (95% CI: 90-100, I2: 87,50%). The best diagnostic tool applied in Indonesia is Xpert MTB/RIF for Rifampicin (RIF), MTBDRplus for Isoniazid (INH), and MGIT for Pyrazinamide (PZA).