Successes, challenges and lessons from a novel deployment of Xpert&lt;SUP&gt;®&lt;/SUP&gt; MTB/RIF at a major South African public event [Short Communication]

Page-Shipp, Liesl; Stevens, Wendy; Clark, David A.; Scott, Lesley; Olsen, Floyd; H, Kisbey-Green; Mametja, David; Churchyard, Gavin J.

doi:10.5588/ijtld.13.0638

Cited by 4 publications

(4 citation statements)

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“…Unfortunately, most diagnostic tests are evaluated primarily in well-funded trials and demonstration studies, without good evidence of how they perform in the real world. For example, Xpert MTB/RIF was recommended on the basis of high-quality data about its accuracy and cost-effectiveness under controlled conditions and in a large field trial 26 ; however, emerging evidence has suggested that, in many settings, the characteristics of Xpert may be different when implemented in the field -including its sensitivity 69 , calibration 70 , positive predictive value (owing to low pre-test probability) 71 , and accuracy for rifampin resistance 72 . To make accurate assessments of the incremental value of diagnostics, we should collect such data early after launch, and update expectations and recommendations as those data become available.…”

Section: S65mentioning

confidence: 99%

Understanding the incremental value of novel diagnostic tests for tuberculosis

Arinaminpathy

Dowdy

2015

Nature

109

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Tuberculosis is a major source of global mortality caused by infection, partly because of a tremendous ongoing burden of undiagnosed disease. Improved diagnostic technology may play an increasingly crucial part in global efforts to end tuberculosis, but the ability of diagnostic tests to curb tuberculosis transmission is dependent on multiple factors, including the time taken by a patient to seek health care, the patient's symptoms, and the patterns of transmission before diagnosis. Novel diagnostic assays for tuberculosis have conventionally been evaluated on the basis of characteristics such as sensitivity and specificity, using assumptions that probably overestimate the impact of diagnostic tests on transmission. We argue for a shift in focus to the evaluation of such tests' incremental value, defining outcomes that reflect each test's purpose (for example, transmissions averted) and comparing systems with the test against those without, in terms of those outcomes. Incremental value can also be measured in units of outcome per incremental unit of resource (for example, money or human capacity). Using a novel, simplified model of tuberculosis transmission that addresses some of the limitations of earlier tuberculosis diagnostic models, we demonstrate that the incremental value of any novel test depends not just on its accuracy, but also on elements such as patient behaviour, tuberculosis natural history and health systems. By integrating these factors into a single unified framework, we advance an approach to the evaluation of new diagnostic tests for tuberculosis that considers the incremental value at the population level and demonstrates how additional data could inform more-effective implementation of tuberculosis diagnostic tests under various conditions

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Section: S65mentioning

confidence: 99%

Understanding the incremental value of novel diagnostic tests for tuberculosis

Arinaminpathy

Dowdy

2015

Nature

109

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“…170-172 Any value of integrating NCDs or TB with HIV clinical care will only be achieved if health systems are capable of providing high-quality clinical care consistently and rapidly.…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

HIV, Tuberculosis, and Noncommunicable Diseases

Hyle

Naidoo

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Unprecedented investments in health systems low- and middle-income countries (LMICs) have resulted in more than eight million individuals on antiretroviral therapy (ART). Such individuals experience dramatically increased survival, but are increasingly at risk of developing common non-communicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different healthcare interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as one example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as two examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV (PLHIV) in LMICs will help to prioritize specific healthcare services by contributing to an understanding of the affordability and implementation of an integrated approach.

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“…The estimated incidence of tuberculosis (TB) in South Africa in 2017 was 567/100,000, and 60% of TB cases were co-infected with HIV. 1 In 2011, the Xpert MTB/RIF (Cepheid, Sunnyvale, CA) test was implemented 2 as the initial screening test for pulmonary TB disease in adults, 3 followed later by its use on specimens from children 4 and extrapulmonary specimens. 5 In 2017, the Xpert was replaced with the Xpert MTB/RIF Ultra (Cepheid).…”

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confidence: 99%