Performance of the Xpert® MTB/RIF assay in an active case-finding strategy: a pilot study from Tanzania [Short communication]

Ntinginya, Elias N.; Squire, S. Bertel; Millington, Kerry; Mtafya, Bariki; Saathoff, Elmar; Heinrich, Norbert; Rojas-Ponce, Gabriel; Kowuor, Dickens; Maboko, Leonard; Reither, Klaus; Clowes, Petra; Höelscher, Michael; Rachow, Andrea

doi:10.5588/ijtld.12.0127

Cited by 30 publications

(19 citation statements)

References 7 publications

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“…The high sensitivity of XpertMTB/RIF implies that an additional 44.4% of HIV positive TB infected individuals who would otherwise be missed by microscopy are diagnosed by XpertMTB/RIF test. Similar microscopy performances when compared to XpertMTB/RIF have been reported in previous studies (Boehme et al, 2010;Theron et al, 2011;Ntinginya et al, 2012;Opota et al, 2016).…”

Section: Discussionsupporting

confidence: 86%

Evaluation of XpertMTB/Rif performance for diagnosis of tuberculosis among HIV positive patients in northern Tanzania

Mollel

Chilongola

Mpagama

et al. 2016

Tanzania J Hlth Res

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Background: Diagnosis of tuberculosis (TB) in patients co-infected with HIV poses an important challenge because of the low sensitivity and specificity of microscopy, the standard diagnostic method. This study aimed to evaluate the performance of the XpertMTB/RIF tool for TB diagnosis among TB-HIV co-infected patients. Methods: This was a cross-sectional analytical study conducted at Kibong'oto Infectious Disease Hospital in northern Tanzania and involved 69 patients. The performance of the XpertMTB/RIF and microscopy using LJ culture were determined and compared. Demographic, clinical, laboratory and radiological data were collected. Results: XpertMTB/RIF had a higher sensitivity (100%), specificity (100%), positive predictive value (79.2%) and negative predictive value (98.9%) as compared to microscopy. There was a strong correlation between XpertMTB/RIF, microscopy and Löwenstein-Jensen (LJ) culture in terms of their sensitivity and specificity. Conclusion: While using TB symptoms screening tool alone in HIV infected individuals may result into overtreatment, relying on microscopy alone has the potential of TB under-diagnosing, miss-diagnosing and delayed treatment. Our results show XpertMTB/RIF to be highly sensitive and specific to detect all culture positive TB cases among HIV patients. We recommend the adoption of XpertMTB/RIF as an early TB diagnosis tool among HIV patients for early detection of TB among HIV patients.

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Section: Discussionsupporting

confidence: 86%

Evaluation of XpertMTB/Rif performance for diagnosis of tuberculosis among HIV positive patients in northern Tanzania

Mollel

Chilongola

Mpagama

et al. 2016

Tanzania J Hlth Res

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“…In addition to the traditional assays, the Xpert ® MTB/RIF assay (Cepheid, Sunnyvale, CA, USA) could potentially contribute to the detection of TB cases. Further to the WHO’s 2011 recommendation that Xpert be used as the initial assay in individuals with suspected PTB, 10 several studies have evaluated Xpert in conjunction with ACF in a variety of settings and populations, with a focus on human immunodeficiency virus infected persons and household contacts of TB cases; 11–15 however, incorporating Xpert into community-based screening in the general population has been explored by relatively few studies, 16,17 and has not been documented in China.…”

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confidence: 99%

Community-based active case finding for tuberculosis in rural western China: a cross-sectional study

Chen

Yang

Gào

et al. 2017

int j tuberc lung dis

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SUMMARY SETTING Current passive case finding strategies are not effective at identifying tuberculosis (TB) patients in rural China. OBJECTIVE To evaluate a community-based, active case finding (ACF) scheme in identifying symptomatic individuals with TB. DESIGN We conducted door-to-door household visits of all residents aged ⩾15 years at two rural sites to screen for TB symptoms. Individuals with symptoms were enrolled and asked to provide three sputum samples. All participants underwent chest X-ray, and microbiologic detection of Mycobacterium tuberculosis from sputum samples using microscopy, solid culture and Xpert® MTB/RIF was performed. RESULTS Among the 19 334 residents screened for TB symptoms, 865 (4.5%) reported having ⩾1 symptom. A total of 52 TB cases were detected, 11 of whom had microbiologic confirmation. Xpert identified all five M. tuberculosis culture-positive cases and yielded an additional three diagnoses. Prevalence of newly detected TB at the two sites through ACF was respectively 475 and 196 per 100 000 population. These estimates are respectively four and eight times, on average, higher than those identified through passive surveillance during the previous 5-year period for the two sites. CONCLUSION Community-based symptom screening followed by laboratory tests was found to be feasible and effective in increasing TB case finding in rural China.

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“…46,47 In practice, TB screening usually starts with either symptoms or X-ray, 48 although there is increasing use of Xpert® MTB/RIF (Cepheid, Sunnyvale, CA, USA) as both initial and confirmatory test. 9,[49][50][51] The performance of all tests tends to be less good due to lower sensitivity when used for screening than for patient-initiated diagnostic testing, as the spectrum of undiagnosed disease detected is shifted towards earlier, paucibacillary cases (Figures 2 and 3): this includes culture, smear microscopy and Xpert. 30,41,49,50,[52][53][54] There is considerable incremental yield from combining different tests, or repeating the same test on different specimens.…”

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confidence: 99%

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Corbett

MacPherson²

2013

int j tuberc lung dis

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SUMMARYTwenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in high human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth of responses as seen in malaria or HIV programmes. Instead, recommendations have been narrowly focused on people presenting to health facilities for investigation of TB symptoms, or for HIV testing and care. However, despite the recent major investment and scale-up of TB and HIV services, undiagnosed TB remains highly prevalent at community level, implying that diagnosis of TB remains slow and incomplete. This maintains high transmission rates and exposes people living with HIV to high rates of morbidity and mortality.More intensive use of TB screening, with broader definitions of target populations, expanded indications for screening both inside and outside of health facilities, and appropriate selection of new diagnostic tools, offers the prospect of rapidly improving population-level control of TB. Diagnostic accuracy of suitable (high throughput) algorithms remains the major barrier to realising this goal.In the present study, we review the evidence available to guide expanded TB screening in HIVprevalent settings, ideally through combined TB-HIV interventions that provide screening for both TB and HIV, and maximise entry to HIV and TB care and prevention. Ideally, we would systematically test, treat and prevent TB and HIV comprehensively, offering both TB and HIV screening to all health facility attendees, TB households and all adults in the highest risk communities. However, we are still held back by inadequate diagnostics, financing and paucity of population-impact data. Relevant contemporary research showing the high need for potential gains, and pitfalls from expanded and intensified TB screening in high HIV prevalence settings are discussed in this review. In high human immunodeficiency virus (HIV) prevalence settings, population-level tuberculosis (TB) incidence increased in parallel with adult HIV prevalence in the 1990s and remains extremely high, with over 1% of adults diagnosed with TB each year in many Southern African towns. 1 Outbreaks of multi-and extensively drug-resistant TB (XDR-TB) have been generated in HIV care clinics, and then spread into general communities. 2,3 Autopsy studies show that TB is the single biggest killer of people living with HIV (PLHIV), being the cause in 32% to 45% of HIV-related deaths 4 and with a high proportion of fatal cases undiagnosed in life. 4,5 Of the estimated 430 000 TB-related deaths among PLHIV during 2011, 79% were in Africa. These stark facts demonstrate the urgent need to strengthen TB prevention and care services using all available approaches, including more ambitious TB screening strategies.TB screening is the first step in both anti-tuberculosis treatment and TB prevention pathways, and has an integral place in routine HIV care and infection control. Key potential entry points for TB screening are illustrated in Figure 1. TB screening c...

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Performance of the Xpert® MTB/RIF assay in an active case-finding strategy: a pilot study from Tanzania [Short communication]

Cited by 30 publications

References 7 publications

Evaluation of XpertMTB/Rif performance for diagnosis of tuberculosis among HIV positive patients in northern Tanzania

Evaluation of XpertMTB/Rif performance for diagnosis of tuberculosis among HIV positive patients in northern Tanzania

Community-based active case finding for tuberculosis in rural western China: a cross-sectional study

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

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