ITEM VIEW

Comparing tuberculosis diagnostic yield in smear/culture and xpert MTB/RIF-based algorithms using a non-randomised stepped-wedge design

dc.contributor.authorNaidoo, Prenen_ZA
dc.contributor.authorDunbar, Roryen_ZA
dc.contributor.authorLombard, Carlen_ZA
dc.contributor.authorDu Toit, Elizabethen_ZA
dc.contributor.authorCaldwell, Judyen_ZA
dc.contributor.authorDetjen, Anneen_ZA
dc.contributor.authorSquire, S. Bertelen_ZA
dc.contributor.authorEnarson, Donald A.en_ZAe
dc.contributor.authorBeyers, Nuldaen_ZA
dc.date.accessioned2016-05-23T14:14:26Z
dc.date.available2016-05-23T14:14:26Z
dc.date.issued2016-03
dc.identifier.citationNaidoo, P., et al. 2016. Comparing tuberculosis diagnostic yield in smear/culture and Xpert MTB/RIF-based algorithms using a non-randomised stepped-wedge design. PLoS ONE, 11(3): 1-13, doi: 10.1371/journal.pone.0150487en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.issn1932-6203 (print)
dc.identifier.otherdoi :10.1371/journal.pone.0150487
dc.identifier.urihttp://hdl.handle.net/10019.1/99004
dc.descriptionCITATION: Naidoo, P., et al. 2016. Comparing tuberculosis diagnostic yield in smear/culture and Xpert MTB/RIF-based algorithms using a non-randomised stepped-wedge design. PLoS ONE, 11(3): 1-13, doi: 10.1371/journal.pone.0150487.en_ZA
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund.
dc.descriptionThe original publication is available at http://journals.plos.org
dc.description.abstractSetting Primary health services in Cape Town, South Africa. Study Aim To compare tuberculosis (TB) diagnostic yield in an existing smear/culture-based and a newly introduced Xpert MTB/RIF-based algorithm. Methods TB diagnostic yield (the proportion of presumptive TB cases with a laboratory diagnosis of TB) was assessed using a non-randomised stepped-wedge design as sites transitioned to the Xpert based algorithm. We identified the full sequence of sputum tests recorded in the electronic laboratory database for presumptive TB cases from 60 primary health sites during seven one-month time-points, six months apart. Differences in TB yield and temporal trends were estimated using a binomial regression model. Results TB yield was 20.9% (95% CI 19.9% to 22.0%) in the smear/culture-based algorithm compared to 17.9% (95%CI 16.4% to 19.5%) in the Xpert based algorithm. There was a decline in TB yield over time with a mean risk difference of -0.9% (95% CI -1.2% to -0.6%) (p<0.001) per time-point. When estimates were adjusted for the temporal trend, TB yield was 19.1% (95% CI 17.6% to 20.5%) in the smear/culture-based algorithm compared to 19.3% (95% CI 17.7% to 20.9%) in the Xpert based algorithm with a risk difference of 0.3% (95% CI -1.8% to 2.3%) (p = 0.796). Culture tests were undertaken for 35.5% of smear-negative compared to 17.9% of Xpert negative low MDR-TB risk cases and for 82.6% of smear-negative compared to 40.5% of Xpert negative high MDR-TB risk cases in respective algorithms. Conclusion Introduction of an Xpert based algorithm did not produce the expected increase in TB diagnostic yield. Studies are required to assess whether improving adherence to the Xpert negative algorithm for HIV-infected individuals will increase yield. In light of the high cost of Xpert, a review of its role as a screening test for all presumptive TB cases may be warranted.en_ZA
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150487
dc.format.extent13 pages
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.subjectTuberculosis -- Diagnosisen_ZA
dc.titleComparing tuberculosis diagnostic yield in smear/culture and xpert MTB/RIF-based algorithms using a non-randomised stepped-wedge designen_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's versionen_ZA
dc.rights.holderAuthors retain copyrighten_ZA


Files in this item

Thumbnail
Thumbnail

This item appears in the following Collection(s)

ITEM VIEW