Evidence map›Paper›PMID 23139799›Full record

ArticlePloS one2012

Impact of Xpert MTB/RIF testing on tuberculosis management and outcomes in hospitalized patients in Uganda.

Christina Yoon, Adithya Cattamanchi, J Lucian Davis, William Worodria, Saskia den Boon, Nelson Kalema, Winceslaus Katagira, Sylvia Kaswabuli, Cecily Miller, Alfred Andama and 5 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02729532 (Z 31411 - The Effect of Xpert MTB/RIF on Patient Health Outcomes and Empirical TB Treatment Among Persons Living With HIV/AIDS), which is not on this map. Cited by 54 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
54citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02729532 completednot on this mapstarted 2016, after this paper: background citation

Z 31411 - The Effect of Xpert MTB/RIF on Patient Health Outcomes and Empirical TB Treatment Among Persons Living With HIV/AIDS: A Parallel-Group Prospective Cohort Study Under Real-World Conditions in Lusaka, Zambia

TypeobservationalSponsorUniversity of North Carolina, Chapel HillRan2016 to 2018Enrolled776ConditionsTuberculosisArmsXpert
3 · Its place in the literature

Who cites it

54 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Pooled it
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  5. Treatment outcomes, diagnostic and therapeutic impact: Xpert vs. smear. A systematic review and meta-analysis.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2019
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  18. Lung function and health-related quality of life among adult patients following pulmonary TB treatment.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2024
    Article
  19. Article
  20. Performance of XpertPublic health action · 2020
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Christina YoonDivision of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA.
Adithya Cattamanchi
J Lucian Davis
William Worodria
Saskia den Boon
Nelson Kalema
Winceslaus Katagira
Sylvia Kaswabuli
Cecily Miller
Alfred Andama
Heidi Albert
Pamela Nabeta
Christen Gray
Irene Ayakaka
Laurence Huang

Funding

Virology CoreP30AI027763 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI STEVEN Grant DEEKS · 1988 to 2026
$93.6M
MUTIDISCIPLINARY TRAINING PROGRAM IN LUNG DISEASEST32HL007185 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI David J Erle, LAURENCE HUANG · 1985 to 2026
$24.6M
International HIV-associated Opportunistic Pneumonias (IHOP) StudyR01HL090335 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HUANG, LAURENCE · 2007 to 2011
$4.0M
Patient-Oriented Research and Mentoring in PneumocystisK24HL087713 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HUANG, LAURENCE · 2006 to 2018
$1.8M
Immunodiagnosis of Active Tuberculosis in HIV-infected PatientsK23HL094141 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI CATTAMANCHI, ADITHYA · 2009 to 2013
$760k
NHLBI NIH HHS K23 HL094141NHLBI NIH HHS K23HL094141NHLBI NIH HHS K24 HL087713NHLBI NIH HHS K24HL087713NHLBI NIH HHS L30 HL110240NHLBI NIH HHS R01 HL090335NHLBI NIH HHS R01HL090335NHLBI NIH HHS T32 HL007185NIAID NIH HHS P30 AI027763PHS HHS K23A1080147
6 · The paper itself

Abstract

rationaleThe clinical impact of Xpert MTB/RIF for tuberculosis (TB) diagnosis in high HIV-prevalence settings is unknown.

objectiveTo determine the diagnostic accuracy and impact of Xpert MTB/RIF among high-risk TB suspects.

methodsWE PROSPECTIVELY ENROLLED CONSECUTIVE, HOSPITALIZED, UGANDAN TB SUSPECTS IN TWO PHASES: baseline phase in which Xpert MTB/RIF results were not reported to clinicians and an implementation phase in which results were reported. We determined the diagnostic accuracy of Xpert MTB/RIF in reference to culture (solid and liquid) and compared patient outcomes by study phase.

results477 patients were included (baseline phase 287, implementation phase 190). Xpert MTB/RIF had high sensitivity (187/237, 79%, 95% CI: 73-84%) and specificity (190/199, 96%, 95% CI: 92-98%) for culture-positive TB overall, but sensitivity was lower (34/81, 42%, 95% CI: 31-54%) among smear-negative TB cases. Xpert MTB/RIF reduced median days-to-TB detection for all TB cases (1 [IQR 0-26] vs. 0 [IQR 0-1], p<0.001), and for smear-negative TB (35 [IQR 22-55] vs. 22 [IQR 0-33], p=0.001). However, median days-to-TB treatment was similar for all TB cases (1 [IQR 0-5] vs. 0 [IQR 0-2], p=0.06) and for smear-negative TB (7 [IQR 3-53] vs. 6 [IQR 1-61], p=0.78). Two-month mortality was also similar between study phases among 252 TB cases (17% vs. 14%, difference +3%, 95% CI: -21% to +27%, p=0.80), and among 87 smear-negative TB cases (28% vs. 22%, difference +6%, 95% CI: -34 to +46%, p=0.77).

conclusionsXpert MTB/RIF facilitated more accurate and earlier TB diagnosis, leading to a higher proportion of TB suspects with a confirmed TB diagnosis prior to hospital discharge in a high HIV/low MDR TB prevalence setting. However, our study did not detect a decrease in two-month mortality following implementation of Xpert MTB/RIF possibly because of insufficient powering, differences in empiric TB treatment rates, and disease severity between study phases.

Indexed as

AdultAntitubercular AgentsDemographyFemaleFollow-Up StudiesHospitalizationHumansMaleMolecular Diagnostic TechniquesSurvival AnalysisTime-to-TreatmentTreatment OutcomeTuberculosisUgandaAntitubercular Agents

Identifiers

PMID23139799
PMCPMC3490868

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.