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Int J Tuberc Lung Dis. 2015 Jul;19(7):811-6. doi: 10.5588/ijtld.15.0013.

The patient impact of point-of-care vs. laboratory placement of Xpert(®) MTB/RIF.

Author information

1
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
2
Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA.
3
Witkoppen Health and Welfare Centre, Johannesburg, South Africa.
4
Clinical HIV Research Unit, Johannesburg, South Africa.
5
Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa; The National Health Laboratory Service, Johannesburg, South Africa.
6
The National Health Laboratory Service, Johannesburg, South Africa.

Abstract

BACKGROUND:

The Xpert(®) MTB/RIF assay can diagnose tuberculosis (TB) rapidly and with great accuracy. The effect of Xpert placement at point of care (POC) vs. at an off-site laboratory on patient management remains unknown.

DESIGN:

At a primary care clinic in Johannesburg, South Africa, we compared TB diagnosis and treatment initiation among 1861 individuals evaluated for pulmonary TB using Xpert performed either at POC or offsite.

RESULTS:

When Xpert was performed at POC, a higher proportion of Xpert-positive individuals started treatment (95% vs. 87%, P = 0.047) and time to treatment initiation was shorter (median 0 vs. 5 days, P < 0.001). In contrast, among Xpert-negative TB cases, a higher proportion (87% vs. 72%, P = 0.001) started treatment when the sample was sent to the laboratory, with a shorter time to treatment (median 9 vs. 13 days, P = 0.056). While the overall proportion of presumed TB patients starting treatment was independent of Xpert placement, the proportion started based on a bacteriologically confirmed diagnosis was higher when Xpert was performed at POC (73% vs. 58%, P = 0.006).

CONCLUSIONS:

Placement of Xpert at POC resulted in more Xpert-positive patients receiving treatment, but did not increase the total number of presumed TB patients starting treatment. When samples were sent to a laboratory for Xpert testing, empiric decision making increased.

PMID:
26056107
PMCID:
PMC4869324
DOI:
10.5588/ijtld.15.0013
[Indexed for MEDLINE]
Free PMC Article

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