The impact of Xpert® MTB/RIF in sparsely populated rural settings

• Published in: The international journal of tuberculosis and lung disease Vol. 19; no. 4; pp. 392 - 398
• Main Authors: Van Den Handel, T., Hampton, K. H., Sanne, I., Stevens, W., Crous, R., Van Rie, A.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.04.2015
• Subjects: Adolescent; Child; Child, Preschool; Coinfection - drug therapy; Female; HIV Infections - drug therapy; Humans; Impact; Male; Microscopy; Point-of-Care Systems; Prospective Studies; Rural; Rural Population; South Africa; Sputum - microbiology; Time-to-Treatment; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - drug therapy; Xpert MTB/RIF; South Africa
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.14.0653

BACKGROUND: The impact of implementing Xpert® MTB/RIF and the choice of instrument placement on patient care in sparsely populated areas with poor access to laboratory and radiology services have not yet been elucidated.METHODS: Prospective evaluation of three diagnostic approaches in the Central Karoo, South Africa: smear microscopy as the initial diagnostic, with sputum processing at centralised laboratories, and Xpert as the initial diagnostic with instrument placement at facility level or centralised laboratory.RESULTS: Of 1449 individuals, 196 were diagnosed with TB. The proportion positive on initial testing was respectively 8%, 20% and 8% during the smear microscopy, decentralised Xpert and centralised Xpert periods. The proportion of bacteriologically confirmed cases was respectively 88%, 99% and 91% during the smear microscopy, decentralised Xpert and centralised Xpert periods. The median time to treatment was respectively 11.5 (interquartile range [IQR] 6-24), 1 (IQR 0-2) and 6 days (IQR 2-9) during the smear microscopy, decentralised Xpert and centralised Xpert periods.CONCLUSION: Introducing Xpert as the initial diagnostic in areas with poor access to TB diagnostics increased the proportion of cases with bacteriological confirmation and reduced time to treatment initiation; however, point-of-care placement may have resulted in fewer people being evaluated for TB.