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Implementation Research to Inform the Use of Xpert MTB/RIF in Primary Health Care Facilities in High TB and HIV Settings in Resource Constrained Settings

Author

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  • Monde Muyoyeta
  • Maureen Moyo
  • Nkatya Kasese
  • Mapopa Ndhlovu
  • Deborah Milimo
  • Winfridah Mwanza
  • Nathan Kapata
  • Albertus Schaap
  • Peter Godfrey Faussett
  • Helen Ayles

Abstract

Background: The current cost of Xpert MTB RIF (Xpert) consumables is such that algorithms are needed to select which patients to prioritise for testing with Xpert. Objective: To evaluate two algorithms for prioritisation of Xpert in primary health care settings in a high TB and HIV burden setting. Method: Consecutive, presumptive TB patients with a cough of any duration were offered either Xpert or Fluorescence microscopy (FM) test depending on their CXR score or HIV status. In one facility, sputa from patients with an abnormal CXR were tested with Xpert and those with a normal CXR were tested with FM (“CXR algorithm”). CXR was scored automatically using a Computer Aided Diagnosis (CAD) program. In the other facility, patients who were HIV positive were tested using Xpert and those who were HIV negative were tested with FM (“HIV algorithm”). Results: Of 9482 individuals pre-screened with CXR, Xpert detected TB in 2090/6568 (31.8%) with an abnormal CXR, and FM was AFB positive in 8/2455 (0.3%) with a normal CXR. Of 4444 pre-screened with HIV, Xpert detected TB in 508/2265 (22.4%) HIV positive and FM was AFB positive in 212/1920 (11.0%) in HIV negative individuals. The notification rate of new bacteriologically confirmed TB increased; from 366 to 620/ 100,000/yr and from 145 to 261/100,000/yr at the CXR and HIV algorithm sites respectively. The median time to starting TB treatment at the CXR site compared to the HIV algorithm site was; 1(IQR 1-3 days) and 3 (2-5 days) (p

Suggested Citation

  • Monde Muyoyeta & Maureen Moyo & Nkatya Kasese & Mapopa Ndhlovu & Deborah Milimo & Winfridah Mwanza & Nathan Kapata & Albertus Schaap & Peter Godfrey Faussett & Helen Ayles, 2015. "Implementation Research to Inform the Use of Xpert MTB/RIF in Primary Health Care Facilities in High TB and HIV Settings in Resource Constrained Settings," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-18, June.
  • Handle: RePEc:plo:pone00:0126376
    DOI: 10.1371/journal.pone.0126376
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    Cited by:

    1. Mardiati Nadjib & Retno Kusuma Dewi & Ery Setiawan & Tri Yunis Miko & Septiara Putri & Panji Fortuna Hadisoemarto & Euis Ratna Sari & Pujiyanto & Rani Martina & Lusi Nursilawati Syamsi, 2022. "Cost and affordability of scaling up tuberculosis diagnosis using Xpert MTB/RIF testing in West Java, Indonesia," PLOS ONE, Public Library of Science, vol. 17(3), pages 1-16, March.
    2. Miriam Harris & Amy Qi & Luke Jeagal & Nazi Torabi & Dick Menzies & Alexei Korobitsyn & Madhukar Pai & Ruvandhi R Nathavitharana & Faiz Ahmad Khan, 2019. "A systematic review of the diagnostic accuracy of artificial intelligence-based computer programs to analyze chest x-rays for pulmonary tuberculosis," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-19, September.

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