Evidence map›Paper›PMID 25734106›Full record

ArticleOpen forum infectious diseases2014

Impact of Xpert MTB/RIF on Antiretroviral Therapy-Associated Tuberculosis and Mortality: A Pragmatic Randomized Controlled Trial.

L Mupfumi, B Makamure, M Chirehwa, T Sagonda, S Zinyowera, P Mason, J Z Metcalfe, R Mutetwa

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Open forum infectious diseases, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 10 pooled it
4.0field-weighted citation impact, top 6% of its field
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 10 syntheses or guidelines pooled it, 63 citations in OpenAlex.

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  4. A systematic review of the number needed to screen for active TB among people living with HIV.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2021
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  9. 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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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

8 authors at 4 institutions in 2 countries.

L MupfumiUniversity of Zimbabwe College of Health Sciences , Harare , Zimbabwe ; Biomedical Research and Training Institute , Zimbabwe.
B MakamureUniversity of Zimbabwe College of Health Sciences , Harare , Zimbabwe ; Biomedical Research and Training Institute , Zimbabwe.
M ChirehwaBiomedical Research and Training Institute , Zimbabwe.
T SagondaBiomedical Research and Training Institute , Zimbabwe.
S ZinyoweraNational Microbiology Reference Laboratory , Harare , Zimbabwe.
P MasonUniversity of Zimbabwe College of Health Sciences , Harare , Zimbabwe ; Biomedical Research and Training Institute , Zimbabwe.
J Z MetcalfeDivision of Pulmonary and Critical Care Medicine , San Francisco General Hospital, and Francis J. Curry International Tuberculosis Center, University of California , San Francisco, California.
R MutetwaBiomedical Research and Training Institute , Zimbabwe.
Biomedical Research and Training Institute · ZWUniversity of Zimbabwe · ZWNational Blood Service Zimbabwe · ZWSan Francisco General Hospital · US

Funding

Virology CoreP30AI027763 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Jae M. Sevelius · 1988 to 2026
$93.6M
Training for Research Excellence and MeNtorship in Tuberculosis (TRENT)D43TW009539 · FIC · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI METCALFE, JOHN ZAPATA · 2013 to 2022
$2.9M
Improving Early Identification of Drug Resistant Tuberculosis in HIV Prevalent SeK23AI094251 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI METCALFE, JOHN ZAPATA · 2011 to 2015
$625k
FIC NIH HHS D43 TW009539NIAID NIH HHS K23 AI094251NIAID NIH HHS P30 AI027763
6 · The paper itself

Abstract

introductionGeneXpert® MTB/RIF (Xpert) is now widely distributed in high human immunodeficiency virus (HIV)/tuberculosis (TB)-burden countries. Yet, whether the test improves patient-important outcomes within HIV treatment programs in limited resource settings is unknown.

methodsTo investigate whether use of Xpert for TB screening prior to initiation of antiretroviral treatment (ART) improves patient-important outcomes, in a pragmatic randomized controlled trial we assigned 424 patients to Xpert or fluorescence sputum smear microscopy (FM) at ART initiation. The primary endpoint was a composite of 3-month mortality and ART-associated TB.

resultsThere was no difference in overall TB diagnosis at ART initiation (20% [n = 43] Xpert vs 21% [n = 45] FM; P = .80), with most patients in both groups treated empirically. There was no difference in time to TB treatment initiation {5 days (interquartile range [IQR], 3-13) vs 8 days [IQR, 3-23; P = .26]} or loss to follow-up (32 [15%] vs 38 [18%]; P = 0.38). Although a nonsignificant reduction in mortality occurred in the Xpert group (11 [6%] vs 17 [10%]; 95% CI, -9% to 2%; P = .19), there was no difference in the composite outcome (9% [n = 17] Xpert vs 12% [n = 21] FM; difference -3%; 95% CI, -9% to 4%).

conclusionsAmong HIV-infected initiating ART, centralized TB screening with Xpert did not reduce the rate of ART-associated TB and mortality, compared with fluorescence microscopy.

Indexed as

ART-associated TBGeneXpert MTB/RIFHIVscreeningtuberculosis

Identifiers

PMID25734106
PMCPMC4324195
OpenAlexW2113252640

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.