The impact of implementing a Xpert MTB/RIF algorithm on drug-sensitive pulmonary tuberculosis: a retrospective analysis

Rees, K. R.; Muditambi, N.; Maswanganyi, M.; Railton, Jean; McIntyre, James; Struthers, Helen; Fourie, P. Bernard; Peters, Remco P. H.

doi:10.1017/s0950268817002746

Cited by 4 publications

(2 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Implementation of the Xpert MTB/RIF assay in various settings has been shown to significantly reduce time to diagnosis, as well as times to first-/second-line treatment initiation and time from diagnosis to negative culture conversion, but data with regard to its impact on treatment outcomes has so far been controversial [28,29]. In a large retrospective study conducted in South Africa, a reduction in the mortality rate in drug-susceptible patients from 14.9% to 9.8% (p <0.001) as well as improvement in treatment success from 71.4 to 84.6% (p <0.001) was seen after 5 years of using Xpert in TB diagnosis [30]. In other studies conducted in settings with medium and high TB and MDR-TB incidence, including one report from Kyiv (Ukraine), routine use of the Xpert MTB/RIF assay was not associated with better outcomes, or only marginal improvements have been observed [7e9,29].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance and impact of routinely implemented Xpert® MTB/RIF assay in a setting of high incidence of drug-resistant TB in Odessa Oblast, Ukraine

Nikolayevskyy

Kontsevaya

Nikolaevskaya³

et al. 2019

Clinical Microbiology and Infection

View full text Add to dashboard Cite

Objectives and methods: The Xpert® MTB/RIF assay (Cepheid, Sunnyvale, CA, USA) has been in routine use in Odessa Oblast, a region with the highest tuberculosis (TB) incidence in Ukraine, since 2013. We assessed the performance of the assay in routine settings and evaluated its effect on treatment outcomes. Results: The sensitivity of Xpert for TB detection was 93.7% (1165/1243) and 69.5% (448/645) for smearpositive and smear-negative sputum specimens, respectively, and its sensitivity for rifampicin resistance was 93.4% (1212/1298). Median time to TB detection using the Xpert assay was 0 days. Treatment initiation within 1 week increased the proportion of successful outcomes (60.1% versus 25.9%, RR ¼ 1.86, 95%CI ¼ 1.46e2.42), but the introduction of Xpert MTB/RIF has not led to a significant improvement in treatment outcomes (57.2% versus 46.2%; RR ¼ 0.93, 95%CI ¼ 0.77e1.12). Conclusion: Performance characteristics of the Xpert assay demonstrated during its routine implementation in an area of high TB and drug-resistant TB incidence in Ukraine were in line with those demonstrated in similar settings elsewhere. Rollout of rapid molecular testing may lead to better treatment results provided that it is implemented in conjunction with other programmatic improvements.

show abstract

Section: Discussionmentioning

confidence: 99%

Diagnostic performance and impact of routinely implemented Xpert® MTB/RIF assay in a setting of high incidence of drug-resistant TB in Odessa Oblast, Ukraine

Nikolayevskyy

Kontsevaya

Nikolaevskaya³

et al. 2019

Clinical Microbiology and Infection

View full text Add to dashboard Cite

show abstract

“…GeneXpert MTB/RIF System (Cepheid, Sunnyvale, CA, Xpert) was launched in 2011 and gradually scaled up nationwide with all smear microscopy laboratories having instruments placed by 2013 10 . Studies have shown that Xpert analyser’s implementation increased both the proportion of individuals initiating TB treatment and the proportion who received a microbiological TB diagnostic test 11 , 12 .…”

Section: Methodsmentioning

confidence: 99%

Tuberculosis testing patterns in South Africa to identify groups that would benefit from increased investigation

Shapiro,

Scott,

Moultrie

et al. 2023

Sci Rep

View full text Add to dashboard Cite

The National Health Laboratory Service (NHLS) collects all public health laboratory test results in South Africa, providing a cohort from which to identify groups, by age, sex, HIV, and viral suppression status, that would benefit from increased tuberculosis (TB) testing. Using NHLS data (2012–2016), we assessed levels and trends over time in TB diagnostic tests performed (count and per capita) and TB test positivity. Estimates were stratified by HIV status, viral suppression, age, sex, and province. We used logistic regression to estimate the odds of testing positive for TB by viral suppression status. Nineteen million TB diagnostic tests were conducted during period 2012–2016. Testing per capita was lower among PLHIV with viral suppression than those with unsuppressed HIV (0.08 vs 0.32) but lowest among people without HIV (0.03). Test positivity was highest among young adults (aged 15–35 years), males of all age groups, and people with unsuppressed HIV. Test positivity was higher for males without laboratory evidence of HIV than those with HIV viral suppression, despite similar individual odds of TB. Our results are an important national baseline characterizing who received TB testing in South Africa. People without evidence of HIV, young adults, and males would benefit from increased TB screening given their lower testing rates and higher test positivity. These high-test positivity groups can be used to guide future expansions of TB screening.

show abstract

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

Horne

Kohli

Zifodya

et al. 2019

Cochrane Database of Systematic Reviews

187

157

View full text Add to dashboard Cite

Background Xpert MTB/RIF (Xpert MTB/RIF) and Xpert MTB/RIF Ultra (Xpert Ultra), the newest version, are the only World Health Organization (WHO)‐recommended rapid tests that simultaneously detect tuberculosis and rifampicin resistance in persons with signs and symptoms of tuberculosis, at lower health system levels. A previous Cochrane Review found Xpert MTB/RIF sensitive and specific for tuberculosis ( ). Since the previous review, new studies have been published. We performed a review update for an upcoming WHO policy review. Objectives To determine diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for tuberculosis in adults with presumptive pulmonary tuberculosis (PTB) and for rifampicin resistance in adults with presumptive rifampicin‐resistant tuberculosis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, to 11 October 2018, without language restriction. Selection criteria Randomized trials, cross‐sectional, and cohort studies using respiratory specimens that evaluated Xpert MTB/RIF, Xpert Ultra, or both against the reference standard, culture for tuberculosis and culture‐based drug susceptibility testing or MTBDR plus for rifampicin resistance. Data collection and analysis Four review authors independently extracted data using a standardized form. When possible, we also extracted data by smear and HIV status. We assessed study quality using QUADAS‐2 and performed meta‐analyses to estimate pooled sensitivity and specificity separately for tuberculosis and rifampicin resistance. We investigated potential sources of heterogeneity. Most analyses used a bivariate random‐effects model. For tuberculosis detection, we first estimated accuracy using all included studies and then only the subset of studies where participants were unselected, i.e. not selected based on prior microscopy testing. Main results We identified in total 95 studies (77 new studies since the previous review): 86 studies (42,091 participants) evaluated Xpert MTB/RIF for tuberculosis and 57 studies (8287 participants) for rifampicin resistance. One study compared Xpert MTB/RIF and Xpert Ultra on the same participant specimen. Tuberculosis detection Of the total 86 studies, 45 took place in high tuberculosis burden and 50 in high TB/HIV burden countries. Most studies had low risk of bias. Xpert MTB/RIF pooled sensitivity and specificity (95% credible Interval (CrI)) were 85% (82% to 88%) and 98% (97% to 98%), (70 studies, 37,237 unselected participants; high‐certainty evidence). We found similar accuracy when ...

show abstract

The impact of implementing a Xpert MTB/RIF algorithm on drug-sensitive pulmonary tuberculosis: a retrospective analysis

Cited by 4 publications

References 21 publications

Diagnostic performance and impact of routinely implemented Xpert® MTB/RIF assay in a setting of high incidence of drug-resistant TB in Odessa Oblast, Ukraine

Diagnostic performance and impact of routinely implemented Xpert® MTB/RIF assay in a setting of high incidence of drug-resistant TB in Odessa Oblast, Ukraine

Tuberculosis testing patterns in South Africa to identify groups that would benefit from increased investigation

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

Contact Info

Product

Resources

About