Tuberculosis (TB) control in Nepal faces persistent challenges due to underdiagnosis and increasing drug resistance. This study assessed the diagnostic performance of the Xpert MTB/RIF assay compared with conventional smear microscopy and estimated the prevalence of rifampicin-resistant TB (RR-TB) in Biratnagar, a high-burden urban center. Between March and September 2023, 509 clinical specimens from TB suspects were analyzed by Ziehl-Neelsen (ZN) staining, fluorescence microscopy (FM), and Xpert MTB/RIF. Using Xpert as the operational reference, ZN and FM exhibited overall sensitivities of 55.9% (89/159) and 68.5% (109/159), respectively. In paired sputum-only analyses (n = 446; sputum Xpert positives = 145), ZN and FM sensitivities were 60.0% (87/145) and 70.3% (102/145), respectively; sputum specificity was 100% for both methods. Xpert detected 31.2% (159/509) positive cases-78.7% more than ZN and 45.9% more than FM. Rifampicin resistance was identified in 5.03% (8/159) of Xpert-positive samples and was strongly associated with prior treatment (P 5% of Xpert-positive patients, higher than national averages for new cases, and a markedly elevated risk among previously treated patients. Rapid detection of resistance permits earlier initiation of appropriate therapy and can reduce onward transmission.
Ojha et al. (2026) studied this question.