Evidence map›Paper›PMID 28911352›Full record

ArticleThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease2017

Missed opportunities for earlier diagnosis of rifampicin-resistant tuberculosis despite access to Xpert

E Mohr, J Daniels, O Muller, J Furin, B Chabalala, S J Steele, V Cox, T Dolby, G Ferlazzo, A Shroufi and 2 more

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Article in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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.

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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

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

E MohrMédecins Sans Frontières (MSF), Khayelitsha, South Africa.
J DanielsMédecins Sans Frontières (MSF), Khayelitsha, South Africa.
O MullerMédecins Sans Frontières (MSF), Khayelitsha, South Africa.
J FurinHarvard Medical School, Boston, Massachusetts, USA.
B ChabalalaMédecins Sans Frontières (MSF), Khayelitsha, South Africa.
S J SteeleMSF, Cape Town.
V CoxMSF, Eshowe, University of Cape Town Center for Infectious Disease Epidemiology and Research, Cape Town.
T DolbyNational Health Laboratory Service, Cape Town.
G FerlazzoMSF, Cape Town.
A ShroufiMSF, Cape Town.
L T DuranMédecins Sans Frontières (MSF), Khayelitsha, South Africa.
H CoxDivision of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.

Funding

Wellcome Trust 099818
6 · The paper itself

Abstract

objectiveTo assess the proportion of rifampicin-resistant tuberculosis (RR-TB) patients with potential earlier RR-TB diagnoses in Khayelitsha, South Africa.

designWe conducted a retrospective analysis among RR-TB patients diagnosed from 2012 to 2014. Patients were considered to have missed opportunities for earlier diagnosis if 1) they were incorrectly screened according to the Western Cape diagnostic algorithm; 2) the first specimen was not tested using Xpert® MTB/RIF; 3) no specimen was ever tested; or 4) the initial Xpert test showed a negative result, but no subsequent specimen was sent for follow-up testing in human immunodeficiency virus-positive patients.

resultsAmong 543 patients, 386 (71%) were diagnosed with Xpert and 112 (21%) had had at least one presentation at a health care facility within the 6 months before the presentation at which RR-TB was diagnosed. Overall, 95/543 (18%) patients were screened incorrectly at some point: 48 at diagnostic presentation only, 38 at previous presentation only, and 9 at both previous and diagnostic presentations.

conclusionsThese data show that a significant proportion of RR-TB patients might have been diagnosed earlier, and suggest that case detection could be improved if diagnostic algorithms were followed more closely. Further training and monitoring is required to ensure the greatest benefit from universal Xpert implementation.

Indexed as

AlgorithmsAntitubercular AgentsFemaleHealth Services AccessibilityHIV InfectionsHumansMaleMass ScreeningMycobacterium tuberculosisRetrospective StudiesRifampinSouth AfricaTime FactorsTuberculosis, Multidrug-ResistantAntitubercular AgentsRifampin

Identifiers

PMID28911352
PMCPMC6548553

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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.