Xpert® MTB/RIF for smear-negative presumptive TB: impact on case notification in DR Congo

Xpert® MTB/RIF for smear-negative presumptive TB: impact on case notification in DR Congo

SETTING: The impact of Xpert® MTB/RIF as a follow-on diagnostic test after smear microscopy on tuberculosis (TB) notification has not yet been well defined.DESIGN: Quasi-experimental design with 86 evaluation and 49 control clinics in Kinshasa, Democratic Republic of Congo. Smear microscopy was supp...

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Bibliographic Details
Published in:The international journal of tuberculosis and lung disease Vol. 20; no. 2; pp. 240 - 246
Main Authors: Mbonze, N. B., Tabala, M., Wenzi, L. K., Bakoko, B., Brouwer, M., Creswell, J., Van Rie, A., Behets, F., Yotebieng, M.
Format: Journal Article
Language:English
Published: France International Union Against Tuberculosis and Lung Disease 01-02-2016
Subjects:
Adolescent
Algorithms
Bacteriological Techniques
Case-Control Studies
Child
Child, Preschool
Critical Pathways
Democratic Republic of the Congo - epidemiology
Developing Countries
Disease Notification
Female
Follow-On Test
Health Services Accessibility
Humans
Male
Microscopy
Mycobacterium tuberculosis - isolation & purification
Predictive Value of Tests
Resource-Poor Settings
Sputum - microbiology
Tb Detection
Time Factors
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - microbiology
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Summary:SETTING: The impact of Xpert® MTB/RIF as a follow-on diagnostic test after smear microscopy on tuberculosis (TB) notification has not yet been well defined.DESIGN: Quasi-experimental design with 86 evaluation and 49 control clinics in Kinshasa, Democratic Republic of Congo. Smear microscopy was supported at all 135 clinics, Xpert was placed in 15 evaluation clinics and a sputum transport system was implemented for 25 satellite clinics. The number of cases notified before and during the project (July 2012-June 2013) was obtained from the National TB Program.RESULTS: Of 27 147 presumptive TB cases presenting in clinics with access to Xpert, 5922 (21.8%) were smear-positive. Of 18 636 individuals with 3 negative microscopy results, 6920 (37.1%) underwent Xpert testing, 991 (14.3%) of whom tested positive. The number of bacteriologically positive cases increased equally in evaluation clinics (15.1%, 95%CI −2.3 to 32.6) and control clinics (13.6%, 95%CI 2.6-29.3), for a difference in increase of 1.5% (95%CI −28.8 to 31.8). There was no difference in the change in smear-negative cases (−42.4%, 95%CI −111.5 to 26.6), nor in all types of TB notified (−6.1%, 95%CI −32.5 to 20.4) between the evaluation and control clinics.CONCLUSION: In part due to a restrictive algorithm, Xpert as follow-on to smear microscopy did not increase the overall number of TB notifications, nor the number of bacteriologically positive cases.
Bibliography:(R) Medicine - General
1027-3719(20160201)20:2L.240;1-
ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1027-3719
1815-7920
DOI:10.5588/ijtld.15.0177