title: Routine use of Xpert® MTB/RIF in areas with different prevalences of HIV and drug-resistant tuberculosis.
abstract: METHODS
  Despite the widespread introduction of Xpert(®) MTB/RIF in developing countries, reports of its use and value in routine conditions remain limited.
  
  
  OBJECTIVE
  To describe Xpert results in relation to microscopy, treatment initiation, cost and workload under routine conditions at four sites in Cambodia, Georgia, Kenya and Swaziland.
  
  
  METHODS
  Laboratory and clinical information on presumed TB patients were obtained from routine registers over a period of at least 6 months between March and November 2012.
  
  
  RESULTS
  Among the 6086 presumed TB patients included in the analysis, Xpert testing increased the number of biologically confirmed cases by 15% to 67% compared to microscopy. Up to 12% of the initial Xpert results were inconclusive. Between 56% and 83% of patients were started on treatment based on microscopy and/or Xpert results, with median delays of 1-16 days. Rifampicin resistance was detected in 3-19% of Xpert-positive patients.
  
  
  CONCLUSIONS
  Despite the additional numbers of cases detected by Xpert compared to microscopy, large proportions of patients are still started on treatment empirically in routine practice. Patient and specimen flow should be optimised to reduce delays in treatment initiation. Simple, non-sputum-based point-of-care tests with high sensitivity are needed to improve TB diagnosis and management.
authors.affiliation: Epicentre, Paris, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Page
authors.affiliation: Operational Center Paris, Médecins Sans Frontières (MSF), Paris, France; Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Ardizzoni
authors.affiliation: MSF Operational Center Geneva, Mbabane, Swaziland.
authors.forename: M
authors.initials: M
authors.lastname: Lassovsky
authors.affiliation: MSF Operational Center Paris, Nairobi, Kenya.
authors.forename: B
authors.initials: B
authors.lastname: Kirubi
authors.affiliation: MSF Operational Center Paris, Abkhazia, Georgia.
authors.forename: D
authors.initials: D
authors.lastname: Bichkova
authors.affiliation: MSF Operational Center Paris, Cambodia.
authors.forename: A
authors.initials: A
authors.lastname: Pedrotta
authors.affiliation: Operational Center Paris, Médecins Sans Frontières (MSF), Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Lastrucci
authors.affiliation: MSF Operational Center Geneva, Geneva, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: de la Tour
authors.affiliation: Epicentre, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bonnet
authors.affiliation: Operational Center Paris, Médecins Sans Frontières (MSF), Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Varaine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial; D013541:Eswatini / Q000453:epidemiology; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D009169:Mycobacterium tuberculosis / Q000235:genetics; D012293:Rifampin / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin