Observational studyPloS one2017
Low implementation of Xpert MTB/RIF among HIV/TB co-infected adults in the International epidemiologic Databases to Evaluate AIDS (IeDEA) program.
Observational study in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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.
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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.
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Who cites it
21 citing papers in PubMed.
- Monocyte-to-Lymphocyte Ratio Is Associated With Tuberculosis Disease and Declines With Anti-TB Treatment in HIV-Infected Children.Journal of acquired immune deficiency syndromes (1999) · 2019Trial
- Literature Review on HIV-Viruses · 2026Review
- Development of a Clinical Prediction Score Including Monocyte-to-Lymphocyte Ratio to Inform Tuberculosis Treatment Among Children With HIV: A Multicountry Study.Open forum infectious diseases · 2022Article
- Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet?Frontiers in neurology · 2022Review
- Controlling Droplet Marangoni Flows to Improve Microscopy-Based TB Diagnosis.Diagnostics (Basel, Switzerland) · 2021Article
- New Developments and Insights in the Improvement ofCurrent epidemiology reports · 2021Review
- Association between GeneXpert Diagnosis and Same-Day Initiation of Tuberculosis Treatment in Rural Eastern Uganda.The American journal of tropical medicine and hygiene · 2020Article
- Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium.Open forum infectious diseases · 2020Article
- CheXaid: deep learning assistance for physician diagnosis of tuberculosis using chest x-rays in patients with HIV.NPJ digital medicine · 2020Article
- Drug-Resistant Tuberculosis and HIV Infection: Current Perspectives.HIV/AIDS (Auckland, N.Z.) · 2020Review
- Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study.Journal of the International AIDS Society · 2019Article
- Quality of care for patients evaluated for tuberculosis in the context of Xpert MTB/RIF scale-up.Journal of clinical tuberculosis and other mycobacterial diseases · 2019Article
- Article
- Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2019Article
- HIV-related tuberculosis: mortality risk in persons without vs. with culture-confirmed disease.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2019Article
- Multidisease testing for HIV and TB using the GeneXpert platform: A feasibility study in rural Zimbabwe.PloS one · 2018Article
- The implementation of Xpert MTB/RIF assay for diagnosis of tuberculosis in Nepal: A mixed-methods analysis.PloS one · 2018Article
- Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016.Gates open research · 2018Article
- Delays in diagnosis and treatment of extrapulmonary tuberculosis in Guatemala.BMJ case reports · 2017Article
- 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
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
objectiveXpert MTB/RIF is recommended by the World Health Organization (WHO) as the initial tuberculosis (TB) diagnostic test in individuals suspected of HIV-associated TB. We sought to evaluate field implementation of Xpert among a cohort of HIV/TB co-infected individuals, including availability, utilization and outcomes.
designObservational cohort study (patient-level data) and cross-sectional study (site-level Xpert availability data).
methodsData were collected at 30 participating International epidemiologic Databases to Evaluate AIDS (IeDEA) sites in 18 countries from January 2012-January 2016. All patients were HIV-infected and diagnosed with TB, either bacteriologically or clinically, and followed until a determination of TB treatment outcome. We used multivariable modified Poisson regression to estimate adjusted relative risk (RR) and 95% confidence intervals for unfavorable TB treatment outcomes.
resultsMost sites (63%) had access to Xpert, either in the clinic (13%), in the same facility (20%) or offsite (30%). Among 2722 HIV/TB patients included, median age was 35.4 years and 41% were female; BMI and CD4 count were low. Overall, most patients (76%) received at least one TB test; 45% were positive. Only 4% of all patients were tested using Xpert: 64% were Xpert-positive, 13% showed rifampicin (RIF) resistance and 30% were extrapulmonary (EPTB) or both pulmonary-EPTB. Treatment outcomes were mostly favorable (77%) and we found little association between Xpert use and an unfavorable TB treatment outcome (RR 1.25, 95%CI: 0.83, 1.90).
conclusionsIn this cohort, Xpert utilization was low even though the majority of sites had access to the test. Our findings show the need for expanded implementation and further research exploring barriers to use in low-resource settings.
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