title: The Feasibility, Accuracy, and Impact of Xpert MTB/RIF Testing in a Remote Aboriginal Community in Canada.
abstract: BACKGROUND
  Xpert MTB/RIF testing for Mycobacterium tuberculosis and rifampin resistance is being used extensively in countries with a high burden of TB. However, recent evidence suggests that it may not have the same accuracy or impact in high-income, low-burden TB countries.
  
  
  METHODS
  A prospective, pragmatic study was done between March 2012 and March 2014 to determine the feasibility, accuracy, and impact on TB disease management provided by the Xpert test in a remote, medically underserved, predominantly Inuit population in Iqaluit, Nunavut, Canada.
  
  
  RESULTS
  A total of 453 Xpert tests were run on sputum samples from 344 patients with suspected TB. Twenty-seven patients were identified as having active TB disease by culture. There were no cases of drug-resistant TB. Using culture as the gold standard, one Xpert test compared with one, two, or three sputum samples cultured per patient had a sensitivity of 85% (95% CI, 66%-95%) and a specificity of 99% (95% CI, 97%-100%) for detection of M tuberculosis. The indeterminate rate was 4.4% of all samples run. Treatment initiation was significantly shortened using Xpert vs the national standard of three smears (1.8 days vs 7.7 days, P < .007) and particularly shorter in smear-negative, culture-positive cases (1.8 days vs 37.1 days, P < .008).
  
  
  CONCLUSIONS
  In a predominantly Inuit population in a remote region of Canada where the burden of TB is high and no TB testing facilities are available, onsite Xpert testing was feasible and accurate and shortened the time to TB treatment initiation.
authors: Department of Medicine, Division of Respirology and Infectious Diseases, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, ON. Electronic address: galvarez@ohri.ca.
authors: Gonzalo G
authors: GG
authors: Alvarez
authors: Department of Medicine, Division of Respirology and Infectious Diseases, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, ON.
authors: Deborah D Van
authors: DDV
authors: Dyk
authors: Department of Laboratory Medicine, Eastern Ontario Regional Laboratories, Ottawa, ON.
authors: Marc
authors: M
authors: Desjardlns
authors: Department of Medicine, Division of Respirology and Infectious Diseases, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, ON.
authors: Abdool S
authors: AS
authors: Yasseen
authors: Department of Medicine, Division of Respirology and Infectious Diseases, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, ON.
authors: Shawn D
authors: SD
authors: Aaron
authors: Department of Medicine, Division of Respirology and Infectious Diseases, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, ON.
authors: D William
authors: DW
authors: Cameron
authors: Nunavut Tunngavik Inc, Iqaluit, NU.
authors: Natan
authors: N
authors: Obed
authors: Department of Health, Government of Nunavut, Iqaluit, NU.
authors: Maureen
authors: M
authors: Baikie
authors: Department of Medicine, Division of Respirology and Infectious Diseases, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, ON.
authors: Smita
authors: S
authors: Pakhale
authors: Respiratory Epidemiology and Clinical Research Unit and McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada.
authors: Claudla M
authors: CM
authors: Denklnger
authors: Respiratory Epidemiology and Clinical Research Unit and McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada.
authors: Hojoon
authors: H
authors: Sohn
authors: Respiratory Epidemiology and Clinical Research Unit and McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada.
authors: Madhukar
authors: M
authors: Pal
mesh_terms: D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D004930:Inuit; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D020957:Nunavut / Q000453:epidemiology; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012293:Rifampin / Q000627:therapeutic use*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin