title: The Application of GeneXpert MTB/RIF for Smear-Negative TB Diagnosis as a Fee-Paying Service at a South Asian General Hospital.
abstract: The GeneXpert MTB/RIF assay (Xpert) is a novel automated diagnostic tool for tuberculosis but its optimal placement in the healthcare system has not been determined. The objective of this study was to determine the possibility of additional case detection for pulmonary tuberculosis (PTB) by offering Xpert to smear-negative patients in a low-HIV burden setting with no Mycobacterium tuberculosis (M.tb.) culture facilities. Patients routinely presenting with symptoms suggestive of PTB with negative smears were offered single Xpert test on a fee-paying basis. Data were retrospectively reviewed to determine case detection in patients tested from February to December 2013. Symptoms associated with a positive test were analysed to determine if refinement of clinical criteria would reduce unnecessary testing. 258 smear-negative patients were included and M.tb. was detected in 55 (21.32%, n = 55/258). Using standard clinical assessment for selection, testing 5 patients detected one case of smear-negative PTB. These results demonstrate that fee-paying Xpert service in low-income setting can increase TB case confirmation substantially and further systematic studies of health economic implications should be conducted to determine optimal implementation models to increase access to Xpert in low- and middle-income countries.
authors.affiliation: Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal.
authors.forename: Poojan
authors.identifier: 0000-0002-1604-082X
authors.initials: P
authors.lastname: Shrestha
authors.affiliation: Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal.
authors.forename: Amit
authors.initials: A
authors.lastname: Arjyal
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK ; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Maxine
authors.initials: M
authors.lastname: Caws
authors.affiliation: Department of Microbiology and Immunology, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal.
authors.forename: Krishna Govinda
authors.initials: KG
authors.lastname: Prajapati
authors.affiliation: Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal.
authors.forename: Abhilasha
authors.initials: A
authors.lastname: Karkey
authors.affiliation: Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal.
authors.forename: Sabina
authors.initials: S
authors.lastname: Dongol
authors.affiliation: Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal.
authors.forename: Saruna
authors.initials: S
authors.lastname: Pathak
authors.affiliation: Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal.
authors.forename: Shanti
authors.initials: S
authors.lastname: Prajapati
authors.affiliation: Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal.
authors.forename: Buddha
authors.initials: B
authors.lastname: Basnyat