Implementation of Xpert MTB/RIF requires quality assessment. A pilot program using dried culture spots (DCSs) of inactivated Mycobacterium tuberculosis is described. Of 274 DCS results received, 2.19% generated errors; the remainder yielded 100% correct Mycobacterium tuberculosis detection. The probe A cycle threshold (C T ) variability of three DCS batches was <3.47. The study of longer-term DCS stability is ongoing.The Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA) (1, 3-5, 9, 12, 13, 15, 19, 25) for the diagnosis of Mycobacterium tuberculosis has recently been endorsed by the WHO (28), and recommendations for data collection to quantify the impact of this GeneXpert (GX) technology are provided (26). Guidance, however, with respect to appropriate external quality assessment (EQA) programs is lacking (17). Current international tuberculosis (TB) EQA programs focus on microscopy, culture, and susceptibility testing laboratories (24) and highlight the difficulties in expansion due to labor-intensive preparatory work and the high cost and regulations associated with shipping drug-resistant isolates (27).Criteria for a verification ("fit for purpose") and EQA program suited to the characteristics of the Xpert MTB/RIF assay (3, 8) will require the following elements. (i) The testing material must contain whole M. tuberculosis (8).(ii) Transportation of EQA material needs to be safe. (iii) The testing procedure needs to be safe and compatible with the Xpert MTB/ RIF current testing protocol. (iv) Health care workers who do not have laboratory skills must be able to perform the testing in nonlaboratory settings. (v) Finally, the programs will need to be cost-effective and sustainable. Such a program using whole inactivated M. tuberculosis spotted onto filter paper was developed and piloted in South Africa as part of the National Health Laboratory Service (NHLS) GX rollout. H37Ra]) and well-characterized local clinical strain MYCTU 15, and (iii) the ATCC 25618 (H37Rv) laboratory strain grown for single-cell-organism suspensions (11). The MGIT cultures S-MYCTU-02-P2 and MYCTU 15 and clinical isolates were pooled in their respective batches (with strains kept separate and not mixed), centrifuged (3,000 ϫ g for 15 min at 4°C) to pellet cells, and resuspended in 40 ml phosphate-buffered saline (PBS) followed by addition of 80 ml (2:1 ratio of buffer to culture) of the Xpert sample reagent (SR) buffer. For the H37Rv strain, 200 ml of culture was harvested (by centrifugation at 3,500 ϫ g) at room temperature for 10 min, and cells were resuspended in PBS to 40 ml followed by addition of 80 ml SR buffer (2:1 ratio of buffer to cells). Both MGIT-grown and H37Rv strain cultures were inactivated in SR buffer for 2 h at room temperature, with intermittent mixing. The inactivated material was washed twice with sterile PBS and resuspended in final volumes of 10 ml (S-MYCTU-02-P2 and MYCTU 15) and 40 ml (H37Rv) PBS. For confirmation of inactivation, washed cultures (0.5 ml) were reinoculated into new MGIT tubes in Bactec cabinets fo...