Systematic screening for drug-resistant tuberculosis with Xpert<SUP>®</SUP> MTB/RIF in a referral hospital in Cambodia

Abstract

Screening presumptive MDR-TB patients with Xpert enabled rapid diagnosis and treatment of MDR-TB. Xpert performed well, provided appropriate risk assessment was done. Rapid confirmatory testing added little to clinical decision making. Our findings support the latest World Health Organization guidelines to abandon confirmatory LPA in favour of repeat Xpert when in clinical doubt, pending phenotypic DST.

Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults

“…We considered 11 studies (19%) to have unclear risk of bias because the manner of participant selection was not reported ( Barmankulova 2015 ; Barnard 2015 ; Bates 2013a ; Huang 2015 ; Kim CH 2015 ; Luetkemeyer 2016 ; Meawed 2016 ; Moussa 2016 ; Nosova 2013a ; Pimkina 2015 ; Singh 2016 ). With respect to applicability, we considered 26 studies (46%) to have low concern because participants in these studies were evaluated in primary care facilities, local hospitals, or both settings ( Al‐Darraji 2013 ; Balcells 2012 ; Barmankulova 2015 ; Boehme 2010 ; Boehme 2011 ; Carriquiry 2012 ; Chikaonda 2017 ; Dorman 2018 ; Friedrich 2011 ; Huang 2015 ; Kurbaniyazova 2017 ; Kurbatova 2013 ; Kwak 2013 ; Lawn 2011 ; Lorent 2015 ; Luetkemeyer 2016 ; Meawed 2016 ; Metcalfe 2016 ; O'Donnell 2015 ; Pimkina 2015 ; Rice 2017 ; Scott 2011 ; Sohn 2014 ; Ssengooba 2014 ; Theron 2011 ; Van Rie 2013 ). We considered four studies to have high concern (7%) because participants were evaluated exclusively as inpatients in tertiary care centres ( Bates 2013a ; Calligaro 2015 ; Kim CH 2015 ; Lippincott 2014 ).…”

“…In the Reference Standard domain, we considered 47 studies (82%) to have low risk of bias because the results of the reference standard were interpreted without knowledge of the results of the index test. We considered four studies (7%) to have high risk of bias because the result of the reference standard was not blinded ( Lorent 2015 ; Safianowska 2012 ; Zeka 2011 ; Zmak 2013 ) and the remaining six studies (11%) to have unclear risk of bias because information was not reported. With respect to applicability in the Reference Standard domain, we considered all studies to have low concern because in these studies all specimens had already been speciated and identified as Mycobacterium tuberculosis .…”

“…Several studies designed to enrol participants suspected of MDR‐TB had high percentages of participants previously treated for tuberculosis ( Lorent 2015 ; Makamure 2017 ; Meawed 2016 ; Metcalfe 2016 ; N'Guessan 2016 ; Pimkina 2015 ; Zetola 2014 ). In these studies (7 studies, 1062 participants), Xpert MTB/RIF pooled sensitivity at 98% (95% CrI 94% to 99%) was higher than the pooled sensitivity of 95% (93% to 97%) in studies that did not preferentially enrol previously treated participants (41 studies, 6958 participants); and conversely, pooled specificity was lower at 97% (93% to 99%) than the pooled specificity of 99% (95% CrI 98% to 99%) in studies that did not preferentially enrol previously treated participants.…”

“…Twenty‐eight studies evaluating Xpert MTB/RIF and involving 8901 participants provided data on a variety of NTMs that grew from the specimens tested, to look for evidence of cross‐reactivity: one NTM ( Al‐Darraji 2013 ); four NTMs ( Balcells 2012 ); two NTMs ( Barnard 2015 ); 50 NTMs ( Bjerrum 2016 ); one NTM ( Chaisson 2014 ); 16 NTMs ( Cowan 2017 ); three NTMs ( Davis 2014 ); 12 NTMs ( Kim CH 2015 ); one NTM ( Kurbatova 2013 ); nine NTMs ( Le Palud 2014 ); 16 NTMs ( Lee 2013 ); 40 NTMs ( Lippincott 2014 ); 14 NTMs ( Lorent 2015 ); 95 NTMs ( Luetkemeyer 2016 ); 20 NTMs ( Moure 2011 ); four NTMs ( Nosova 2013a ); 10 NTMs ( Pinyopornpanish 2015 ); 45 NTMs ( Rachow 2011 ); 122 NTMs ( Rice 2017 ); seven NTMs ( Safianowska 2012 ); five NTMs ( Scott 2011 ); three NTMs ( Sohn 2014 ); 19 NTMs ( Ssengooba 2014 ); two NTMs ( Tang 2017 ); eight NTMs ( Theron 2011 ); three NTMs ( Van Rie 2013 ); 22 NTMs ( Williamson 2012 ); and two NTMs ( Zmak 2013 ). Among these 28 studies comprising 536 NTMs, Xpert MTB/RIF was positive in 16 specimens that grew NTMs, pooled proportion 2.0% (0.4% to 4.4%).…”

The Infomóvel—An information system for managing HIV/AIDS patients in rural areas of Mozambique

“…Active case finding techniques for both HIV and TB within communities thought to be at high risk have been supported, similar to the index case methods used by Infomóvel [ 35 ]. In Cambodia, CHWs conducted active door-to-door screening and sputum sample collection for TB, sending test results and referrals via SMS to the health facility [ 36 ].…”