| Title: |
The impact of implementing a Xpert MTB/RIF algorithm on drug-sensitive pulmonary tuberculosis: a retrospective analysis |
| Authors: |
Rees, K.; Muditambi, N.; Maswanganyi, M.; Railton, J.; Mcintyre, J. A.; Struthers, H. E.; Fourie, P. B.; Peters, R. P. H. |
| Source: |
Rees, K, Muditambi, N, Maswanganyi, M, Railton, J, Mcintyre, J A, Struthers, H E, Fourie, P B & Peters, R P H 2018, 'The impact of implementing a Xpert MTB/RIF algorithm on drug-sensitive pulmonary tuberculosis: a retrospective analysis', Epidemiology and Infection, vol. 146, no. 2, pp. 246-255. https://doi.org/10.1017/S0950268817002746 |
| Publication Year: |
2018 |
| Collection: |
Maastricht University Research Publications |
| Subject Terms: |
Diagnostic trend; HIV; tuberculosis; Xpert; CASE NOTIFICATION RATES; SOUTH-AFRICA; ANTIRETROVIRAL THERAPY; ROLL-OUT; SCALE-UP; ART; TB; MORTALITY; PROGRAMS; ACCURACY |
| Description: |
Xpert MTB/RIF (Xpert) is the preferred first-line test for all persons with tuberculosis (TB) symptoms in South Africa in line with a diagnostic algorithm. This study evaluates pre- and post-implementation trends in diagnostic practices for drug-sensitive, pulmonary TB in adults in an operational setting, following the introduction of the Xpert-based algorithm. We retrospectively analysed data from the national TB database for Greater Tzaneen sub-district, Limpopo Province. Trends in a number of cases, diagnosis and outcome and characteristics associated with death are reported. A total of 8407 cases were treated from 2008 until 2015, with annual cases registered decreasing by 31.7% over that time period (from 1251 to 855 per year). After implementation of Xpert, 69.9% of cases were diagnosed by Xpert, 29.4% clinically, 0.6% by smear microscopy and 0.1% by culture. Cases with a recorded microbiological test increased from 76.2% to 96.4%. Cases started on treatment without confirmation, but with a negative microbiological test increased from 7.1% to 25.7%. Case fatality decreased from 15.0% to 9.8%, remaining consistently higher in empirically treated groups, regardless of HIV status. Implementation of the algorithm coincided with a reduced number of TB cases treated and improved coverage of microbiological testing; however, a substantial proportion of cases continued to start treatment empirically. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
0950-2688; 1469-4409 |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/29208074; info:eu-repo/semantics/altIdentifier/wos/000423547900012; info:eu-repo/semantics/altIdentifier/pissn/0950-2688; info:eu-repo/semantics/altIdentifier/eissn/1469-4409 |
| DOI: |
10.1017/S0950268817002746 |
| Availability: |
https://cris.maastrichtuniversity.nl/en/publications/503b5af7-062f-46d0-8a5d-bb218e318412; https://doi.org/10.1017/S0950268817002746; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9134741 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.4FF2F9C3 |
| Database: |
BASE |