{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:05:40Z","timestamp":1790186740485,"version":"4.1.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"USAID Zambia","award":["72061120CA00001"],"award-info":[{"award-number":["72061120CA00001"]}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Zambia continues to face a high-Tuberculosis burden with rising drug resistance, yet diagnosis of non-rifampicin resistant drug-resistance remains limited due to reliance on rifampicin as a proxy for multidrug-resistant tuberculosis. The Xpert MTB\/XDR assay offers a rapid detection of resistance to isoniazid, fluoroquinolone, Ethionamide and aminoglycosides, addressing a major diagnostic gap. The aim of this analysis was to describe the prevalence and profile of drug resistance among bacteriologically confirmed TB patients subjected to reflex Xpert MTB\/XDR testing. We conducted an analysis of programmatic data from a four-week active drug-resistant TB case finding surge in May 2025, implemented across 39 high-TB burden facilities in five provinces of Zambia. We re-evaluated eligible Xpert MTB\/RIF Ultra positive TB patients using the Xpert MTB\/XDR platform regardless of Rifampicin resistance to identify additional drug resistance beside rifampicin. We analyzed patient demographics, characteristics, and the distribution of drug resistance drug-resistance categories descriptively. Of 509 TB patients identified, 70.9%(n\u2009=\u2009360) were bacteriologically confirmed by Xpert MTB\/RIF Ultra among whom 92.8%(n\u2009=\u2009336) were eligible for reflex Xpert MTB\/XDR testing. Of the eligible, 89.3% (n\u2009=\u2009313) underwent reflex Xpert MTB\/XDR testing. Results were successfully retrieved for 282 (90.1%). Overall, 8.5%(n\u2009=\u200924) of patients with XDR results had a form of drug-resistant tuberculosis. Mono-resistance to rifampicin (3.5%, n\u2009=\u200910) or isoniazid (3.2%, n\u2009=\u20099) was more prevalent than multi-drug-resistant tuberculosis (1.1%, n\u2009=\u20093), while only 0.4% (n\u2009=\u20091) had Pre-XDR TB. Non-rifampicin resistant drug-resistance, including isoniazid mono-resistance and isoniazid combined with fluoroquinolone or ethionamide resistance, were detected in 3.2% (n\u2009=\u20099) of all patients with XDR TB results (37.5% of all DR-TB cases). Reflex Xpert MTB\/XDR testing enabled rapid identification of non-rifampicin-resistance drug-resistant TB cases that would have been missed by rifampicin-centric diagnostics. Strengthening the integration of MTB\/XDR into routine diagnostic algorithms can improve early drug-resistant tuberculosis detection, guide individualized treatment, and prevent amplification of resistance in high-burden settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005536","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:25:41Z","timestamp":1790184341000},"page":"e0005536","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rapid detection of non-rifampicin resistant drug-resistant tuberculosis using Xpert MTB\/XDR testing: Findings from a multisite drug-resistant tuberculosis case detection surge in Zambia"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3275-4934","authenticated-orcid":true,"given":"Phallon Blessing","family":"Mwaba","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia","place":["Lusaka, Zambia"],"department":["Department of Tuberculosis and other Respiratory Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4350-5482","authenticated-orcid":true,"given":"Marshal","family":"Sikandangwa","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia","place":["Lusaka, Zambia"],"department":["Department of Tuberculosis and other Respiratory Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robertson","family":"Chibumbya","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia","place":["Lusaka, Zambia"],"department":["Department of Tuberculosis and other Respiratory Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8869-7054","authenticated-orcid":true,"given":"Innocent","family":"Mwaba","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia","place":["Lusaka, Zambia"],"department":["Department of Tuberculosis and other Respiratory Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minyoi Mubita","family":"Maimbolwa","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia","place":["Lusaka, Zambia"],"department":["Department of Tuberculosis and other Respiratory Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1186-5045","authenticated-orcid":true,"given":"Chitalu","family":"Chanda","sequence":"additional","affiliation":[{"name":"Ministry of Health, Zambia, National Tuberculosis and Leprosy Programme","place":["Lusaka, Zambia"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Mputu","sequence":"additional","affiliation":[{"name":"Ministry of Health, Zambia, National Tuberculosis and Leprosy Programme","place":["Lusaka, Zambia"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhehab","family":"Chimzizi","sequence":"additional","affiliation":[{"name":"Ministry of Health, Zambia, National Tuberculosis and Leprosy Programme","place":["Lusaka, Zambia"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin Mabvuto","family":"Zimba","sequence":"additional","affiliation":[{"name":"Health Coordination Office, United States Embassy","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8219-8043","authenticated-orcid":true,"given":"Nancy Kasese","family":"Chanda","sequence":"additional","affiliation":[{"name":"Ministry of Health, Zambia, National Tuberculosis and Leprosy Programme","place":["Lusaka, Zambia"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel","family":"Mubanga","sequence":"additional","affiliation":[{"name":"Ministry of Health, Zambia, National Tuberculosis and Leprosy Programme","place":["Lusaka, Zambia"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3609-5403","authenticated-orcid":true,"given":"Monde","family":"Muyoyeta","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia","place":["Lusaka, Zambia"],"department":["Department of Tuberculosis and other Respiratory Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Kagujje","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia","place":["Lusaka, Zambia"],"department":["Department of Tuberculosis and other Respiratory Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"pgph.0005536.ref001","unstructured":"WHO. 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