ArticlePloS one2018
The implementation of Xpert MTB/RIF assay for diagnosis of tuberculosis in Nepal: A mixed-methods analysis.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 4 of them syntheses that pooled it.
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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
25 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Implementation strategies to increase the uptake and impact of molecular WHO-recommended rapid diagnostic tests: evidence from a mixed-methods systematic review.BMJ global health · 2025Pooled it
- Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2024Pooled it
- Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis of recipient and provider views.The Cochrane database of systematic reviews · 2022Pooled it
- Implementation of GeneXpert for TB Testing in Low- and Middle-Income Countries: A Systematic Review.Global health, science and practice · 2021Pooled it
- Xpert MTB/XDR performance in non-sputum samples for diagnosis of drug-resistant tuberculosis at a North Indian tertiary care center.Journal of clinical microbiology · 2026Article
- Comparative evaluation of sputum microscopy and Xpert MTB/RIF assay for tuberculosis detection and rifampicin resistance surveillance in Biratnagar, Nepal.Microbiology spectrum · 2026Article
- Diagnostic accuracy of TB-LAMP and smear microscopy for pulmonary TB in active case finding.IJTLD open · 2026Article
- Cost-benefit analysis of pre-entry tuberculosis screening for incoming migrants to Japan: a focus on Nepalese migrants.Health economics review · 2025Article
- Patient and health system delays in the diagnosis and treatment of tuberculosis in Gandaki, Nepal.PLOS global public health · 2025Article
- Analysis of unsuccessful tests and the effect of prolonged clinical sample preprocessing in the GeneXpert MTB/RIF assay.BMC infectious diseases · 2024Article
- Finding the missed millions: innovations to bring tuberculosis diagnosis closer to key populations.BMC global and public health · 2024Review
- Article
- Diagnostic Performance of Multiplex PCR for Detection ofJournal of laboratory physicians · 2022Article
- Article
- A prospective multicentre diagnostic accuracy study for the Truenat tuberculosis assays.The European respiratory journal · 2021Article
- Article
- Article
- Development and performance of CUHAS-ROBUST application for pulmonary rifampicin-resistance tuberculosis screening in Indonesia.PloS one · 2021Article
- Performance of XpertPublic health action · 2020Article
- Study protocol: a cluster randomized trial to evaluate the effectiveness and implementation of onsite GeneXpert testing at community health centers in Uganda (XPEL-TB).Implementation science : IS · 2020Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTuberculosis (TB) is a major public health problem in low and middle-income countries. Early detection and enrolment of TB cases is a challenge for National TB Programs.
objectiveTo understand the performance and feasibility for scale-up of Xpert MTB/RIF assay for the TB diagnosis in Nepal.
designImplementation research employed mixed-method sequential explanatory design. The results of Xpert MTB/RIF assay were analysed in 26 TB diagnostic centres where Xpert machines had been installed before 2015. In-depth interviews and focus group discussions were conducted with stakeholders, purposively selected to represent experiences in centres that were functioning well, poorly or not functioning.
resultsDuring a one-year period in 2015/16, 23,075 Xpert MTB/RIF assays were performed in 21 diagnostic centres with 22,288 people also tested by sputum microscopy. Among these, 77% had concordant (positive or negative) results, demonstrating fair agreement (Kappa score, 0.3) between test results. Test failure and positivity rates in diagnostic centres ranged from 2.6% to 13.4% and 6.5% to 49%, respectively. The number of cartridges per positive result varied from 2.3 to 10.2. Xpert assay was positive in 3314 (15% of all cases) sputum smear microscopy negative cases. Of 4280 bacteriologically confirmed cases by Xpert assay, 355 (8%) were rifampicin resistant. Xpert machines were no longer functioning regularly throughout the year in 5 diagnostic centres. The main barriers for effective implementation of Xpert in Nepal were the lack of: timely supply of cartridges; replacement of damaged modules; maintenance of Xpert machines; and stock verification for timely procurement of cartridges. Inadequate laboratory infrastructure for maintaining functional Xpert equipment further challenges implementation and scale-up.
conclusionThe implementation of Xpert MTB/RIF assay has increased case-finding of TB and MDR-TB in Nepal. However, there is a need to improve laboratory performance and strengthen laboratory infrastructure for optimal utilisation and scale-up of Xpert.
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