ArticleJournal of acquired immune deficiency syndromes (1999)2014
Diagnostic delays and clinical decision making with centralized Xpert MTB/RIF testing in Durban, South Africa.
Article in Journal of acquired immune deficiency syndromes (1999), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01188941 (Linkage and Retention), which is not on this map. Cited by 25 papers, 5 of them syntheses that pooled it.
What it found
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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.
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.
Linkage and Retention: A Randomized Trial to Optimize HIV/TB Care in South Africa
Who cites it
25 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Implementation strategies to increase the uptake and impact of molecular WHO-recommended rapid diagnostic tests: evidence from a mixed-methods systematic review.BMJ global health · 2025Pooled it
- Impact of molecular diagnostic tests on diagnostic and treatment delays in tuberculosis: a systematic review and meta-analysis.BMC infectious diseases · 2022Pooled it
- Diagnostic accuracy of WHO screening criteria to guide lateral-flow lipoarabinomannan testing among HIV-positive inpatients: A systematic review and individual participant data meta-analysis.The Journal of infection · 2022Pooled it
- Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis.The Lancet. Infectious diseases · 2022Pooled it
- Impact of Molecular Diagnostics for Tuberculosis on Patient-Important Outcomes: A Systematic Review of Study Methodologies.PloS one · 2016Pooled it
- National Implementation of a Tuberculosis Sample Referral Network to Expand Access to Molecular Diagnosis in the Republic of Congo: Pilot Evaluation and Programmatic Analysis (2023-2025).Tropical medicine and infectious disease · 2026Article
- Impact of sputum quality on Xpert MTB/RIF Ultra test results for tuberculosis: A multi-country study.medRxiv : the preprint server for health sciences · 2026Article
- Optimizing hepatitis B diagnosis for mothers in a low-resource setting: A field pilot of Xpert point-of-care viral load testing in Ugandan antenatal clinics.PLOS global public health · 2026Article
- Validation of Nova Stat Profile Prime Plus point-of-care testing for dialysis in South Africa.African journal of laboratory medicine · 2025Article
- Study protocol: a pragmatic, cluster-randomized controlled trial to evaluate the effect of implementation of the Truenat platform/MTB assays at primary health care clinics in Mozambique and Tanzania (TB-CAPT CORE).BMC infectious diseases · 2024Article
- Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa.PloS one · 2024Article
- Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China.BMC infectious diseases · 2020Article
- Quality of TB care among people living with HIV: Gaps and solutions.Journal of clinical tuberculosis and other mycobacterial diseases · 2019Review
- Impact of GxAlert on the management of rifampicin-resistant tuberculosis patients, Port Moresby, Papua New Guinea.Public health action · 2019Article
- A review of microsampling techniques and their social impact.Biomedical microdevices · 2019Review
- Point of care Xpert MTB/RIF versus smear microscopy for tuberculosis diagnosis in southern African primary care clinics: a multicentre economic evaluation.The Lancet. Global health · 2019Article
- Performance and workflow assessment of six nucleic acid extraction technologies for use in resource limited settings.PloS one · 2019Article
- Dynamic Clinical Algorithms: Digital Technology Can Transform Health Care Decision-Making.The American journal of tropical medicine and hygiene · 2018Article
- Implications of Failure to Routinely Diagnose Resistance to Second-Line Drugs in Patients With Rifampicin-Resistant Tuberculosis on Xpert MTB/RIF: A Multisite Observational Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2017Observational
- Evaluation of gene xpert for routine diagnosis of HIV-associated tuberculosis in Nigeria: A prospective cohort study.BMC pulmonary medicine · 2017Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
settingWe conducted a retrospective study among HIV-infected adult suspects (≥18 years) with pulmonary tuberculosis (TB), who underwent Xpert MTB/RIF (Xpert) testing at McCord Hospital and its adjoining HIV clinic in Durban, South Africa.
objectiveTo determine if Xpert testing performed at a centralized laboratory accelerated time to TB diagnosis.
designWe obtained data on sputum smear microscopy [acid-fast bacilli (AFB)], Xpert, and the rationale for treatment initiation from medical records. The primary outcome was "total diagnostic time," defined as time from sputum collection to clinicians' receipt of results. A linear mixed-effect model compared the duration of steps in the diagnostic pathway across testing modalities.
resultsAmong 403 participants, the median "total diagnostic time" for AFB and Xpert was 3.3 and 6.4 days, respectively (P < 0.001). When compared with AFB, the median delay for Xpert "laboratory processing" was 1.4 days (P < 0.001) and "result transfer to clinic" was 1.7 days (P < 0.001). Among 86 Xpert-positive participants who initiated treatment, 49 (57%) started treatment based on clinical suspicion or AFB-positive results, whereas only 32 (37%) started treatment based on Xpert-positive results.
conclusionsIn our setting, Xpert results took twice as long as AFB results to reach clinicians. Replacing AFB with centralized Xpert may delay TB diagnoses in some settings.
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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.