ArticlePloS one2015
Catching the missing million: experiences in enhancing TB & DR-TB detection by providing upfront Xpert MTB/RIF testing for people living with HIV in India.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 7 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 7 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- Gender and other intersecting factors in antimicrobial resistance for infectious diseases of poverty: a systematic evidence gap analysis in low- and lower-middle-income countries.BMC public health · 2026Pooled it
- Review: missed tuberculosis cases in India: a systematic analysis of diagnostic, treatment, and reporting gaps.BMC health services research · 2025Pooled it
- Xpert MTB/RIF Ultra assay for tuberculosis disease and rifampicin resistance in children.The Cochrane database of systematic reviews · 2022Pooled it
- Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis.The Cochrane database of systematic reviews · 2021Pooled it
- Differential yield of universal versus selective drug susceptibility testing of patients with tuberculosis in high-burden countries: a systematic review and meta-analysis.BMJ global health · 2020Pooled it
- Xpert MTB/RIF and Xpert MTB/RIF Ultra assays for active tuberculosis and rifampicin resistance in children.The Cochrane database of systematic reviews · 2020Pooled it
- Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults.The Cochrane database of systematic reviews · 2019Pooled it
- Integrating Xpert MTB/RIF for TB diagnosis in the private sector: evidence from large-scale pilots in Patna and Mumbai, India.BMC infectious diseases · 2021Article
- Multidrug-Resistant Tuberculosis in Patients with Human Immunodeficiency Virus. Management Considerations within High-resourced Settings.Annals of the American Thoracic Society · 2020Review
- Drug-Resistant Tuberculosis and HIV Infection: Current Perspectives.HIV/AIDS (Auckland, N.Z.) · 2020Review
- New Machine, Old Cough: Technology and Tuberculosis in Patna.Frontiers in sociology · 2020Article
- High prevalence of multi drug resistant tuberculosis in people living with HIV in Western India.BMC infectious diseases · 2019Article
- Performance of and Factors Associated With Tuberculosis Screening and Diagnosis Among People Living With HIV: Analysis of 2012-2016 Routine HIV Data in Tanzania.Frontiers in public health · 2019Article
- A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas.Infectious diseases of poverty · 2018Article
- Unsuccessful XpertPublic health action · 2018Article
- Missed opportunities for earlier diagnosis of rifampicin-resistant tuberculosis despite access to XpertThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2017Article
- Diagnosis of opportunistic infections: HIV co-infections - tuberculosis.Current opinion in HIV and AIDS · 2017Review
- Development, roll-out and impact of Xpert MTB/RIF for tuberculosis: what lessons have we learnt and how can we do better?The European respiratory journal · 2016Review
- Article
- Rapid Detection of Mycobacterium tuberculosis in Sputum Samples by Cepheid Xpert Assay: A Clinical Study.Journal of clinical and diagnostic research : JCDR · 2015Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundA critical challenge in providing TB care to People Living with HIV (PLHIV) is establishing an accurate bacteriological diagnosis. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents results from PLHIV taking part in a large demonstration study across India wherein upfront Xpert MTB/RIF testing was offered to all presumptive PTB cases in public health facilities.
methodThe study covered a population of 8.8 million across 18 sub-district level tuberculosis units (TU), with one Xpert MTB/RIF platform established at each TU. All HIV-infected patients suspected of TB (both TB and Drug Resistant TB (DR-TB)) accessing public health facilities in study area were prospectively enrolled and provided upfront Xpert MTB/RIF testing.
result2,787 HIV-infected presumptive pulmonary TB cases were enrolled and 867 (31.1%, 95% Confidence Interval (CI) 29.4‒32.8) HIV-infected TB cases were diagnosed under the study. Overall 27.6% (CI 25.9-29.3) of HIV-infected presumptive PTB cases were positive by Xpert MTB/RIF, compared with 12.9% (CI 11.6-14.1) who had positive sputum smears. Upfront Xpert MTB/RIF testing of presumptive PTB and DR-TB cases resulted in diagnosis of 73 (9.5%, CI 7.6‒11.8) and 16 (11.2%, CI 6.7‒17.1) rifampicin resistance cases, respectively. Positive predictive value (PPV) for rifampicin resistance detection was high 97.7% (CI 89.3‒99.8), with no significant difference with or without prior history of TB treatment.
conclusionThe study results strongly demonstrate limitations of using smear microscopy for TB diagnosis in PLHIV, leading to low TB and DR-TB detection which can potentially lead to either delayed or sub-optimal TB treatment. Our findings demonstrate the usefulness and feasibility of addressing this diagnostic gap with upfront of Xpert MTB/RIF testing, leading to overall strengthening of care and support package for PLHIV.
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