ArticleBulletin of the World Health Organization2017
The impact of the roll-out of rapid molecular diagnostic testing for tuberculosis on empirical treatment in Cape Town, South Africa.
Article in Bulletin of the World Health Organization, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04433195 (Xpert MTB/RIF Test as the Initial Diagnostic Test in the Diagnosis of Pulmonary Tuberculosis), which is not on this map. Cited by 25 papers, 2 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.
Xpert MTB/RIF Test as the Initial Diagnostic Test in the Diagnosis of Pulmonary Tuberculosis: a Pragmatic Trial
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Impact of the diagnostic test Xpert MTB/RIF on patient outcomes for tuberculosis.The Cochrane database of systematic reviews · 2021Pooled it
- Effect of Xpert MTB/RIF on clinical outcomes in routine care settings: individual patient data meta-analysis.The Lancet. Global health · 2019Pooled it
- Management of patients with tuberculosis medication-induced drug reaction with eosinophilia and systemic symptoms.Current opinion in allergy and clinical immunology · 2025Review
- Spatial clusters of risk and cartography of care for drug-resistant tuberculosis.Revista de saude publica · 2025Article
- Surveillance for TB drug resistance using routine rapid diagnostic testing data: Methodological development and application in Brazil.PLoS computational biology · 2024Article
- Prolongation of Acid-Fast Bacilli Sputum Smear Positivity in Patients with Multidrug-Resistant Pulmonary Tuberculosis.Pathogens (Basel, Switzerland) · 2023Article
- Analysis of Discordance between Genotypic and Phenotypic Assays for Rifampicin-ResistantPathogens (Basel, Switzerland) · 2023Article
- Do private providers initiate anti-tuberculosis therapy on the basis of chest radiographs? A standardised patient study in urban India.The Lancet regional health. Southeast Asia · 2023Article
- Nucleic acid amplification tests reduce delayed diagnosis and misdiagnosis of pulmonary tuberculosis.Scientific reports · 2022Article
- Membrane Technology for Rapid Point-of-Care Diagnostics for Parasitic Neglected Tropical Diseases.Clinical microbiology reviews · 2021Article
- HIV-associated tuberculosis.International journal of STD & AIDS · 2021Article
- High Rates of Recurrent Tuberculosis Disease: A Population-level Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Case Report: Therapeutic Threshold for Rifampicin-Resistant Tuberculosis in a Patient from Maputo, Mozambique.The American journal of tropical medicine and hygiene · 2021Article
- 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
- Strengthening health systems to improve the value of tuberculosis diagnostics in South Africa: A cost and cost-effectiveness analysis.PloS one · 2021Article
- 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
- Sputum smear microscopy in the XpertThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2019Article
- REASSURED diagnostics to inform disease control strategies, strengthen health systems and improve patient outcomes.Nature microbiology · 2019Review
- Empiric treatment of pulmonary TB in the Xpert era: Correspondence of sputum culture, Xpert MTB/RIF, and clinical diagnoses.PloS one · 2019Article
- Article
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Authors and funding
5 authors.
Funding
Abstract
objectiveTo investigate the impact of introducing a rapid test as the first-line diagnostic test for drug-sensitive tuberculosis in Cape Town, South Africa.
methodsXpert® MTB/RIF (Xpert®), an automated polymerase-chain-reaction-based assay, was rolled out between 2011 and 2013. Data were available on 102 007 adults treated for pulmonary tuberculosis between 2010 and 2014. Tuberculosis notification rates per 100 000 population were calculated for each calendar year and for each year relative to the test roll-out locally, overall and by bacteriological confirmation. Empirical treatment was defined as treatment given without bacteriological confirmation by Xpert®, sputum smear microscopy or sputum culture.
findingsBetween 2010 and 2014, the proportion of human immunodeficiency virus (HIV)-negative patients treated empirically for tuberculosis declined from 23% (2445/10 643) to 11% (1149/10 089); in HIV-positive patients, it declined from 42% (4229/9985) to 27% (2364/8823). The overall tuberculosis notification rate decreased by 12% and 19% among HIV-negative and HIV-positive patients, respectively; the rate of bacteriologically confirmed cases increased by 1% and 3%, respectively; and the rate of empirical treatment decreased by 56% and 49%, respectively. These changes occurred gradually following the test's introduction and stabilized after 3 years.
conclusionRoll-out of the rapid test in a setting with a high prevalence of pulmonary tuberculosis and HIV infection was associated with a halving of empirical treatment that occurred gradually after the test's introduction, possibly reflecting the time needed for full implementation. More than a quarter of HIV-positive patients with tuberculosis were still treated empirically, highlighting the diagnostic challenge in these patients.
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