title: Xpert(®) MTB/RIF for smear-negative presumptive TB: impact on case notification in DR Congo.
abstract: METHODS
  The impact of Xpert(®) MTB/RIF as a follow-on diagnostic test after smear microscopy on tuberculosis (TB) notification has not yet been well defined.
  
  
  METHODS
  Quasi-experimental design with 86 evaluation and 49 control clinics in Kinshasa, Democratic Republic of Congo. Smear microscopy was supported at all 135 clinics, Xpert was placed in 15 evaluation clinics and a sputum transport system was implemented for 25 satellite clinics. The number of cases notified before and during the project (July 2012-June 2013) was obtained from the National TB Program.
  
  
  RESULTS
  Of 27,147 presumptive TB cases presenting in clinics with access to Xpert, 5922 (21.8%) were smear-positive. Of 18,636 individuals with ⩾ 3 negative microscopy results, 6920 (37.1%) underwent Xpert testing, 991 (14.3%) of whom tested positive. The number of bacteriologically positive cases increased equally in evaluation clinics (15.1%, 95%CI -2.3 to 32.6) and control clinics (13.6%, 95%CI 2.6-29.3), for a difference in increase of 1.5% (95%CI -28.8 to 31.8). There was no difference in the change in smear-negative cases (-42.4%, 95%CI -111.5 to 26.6), nor in all types of TB notified (-6.1%, 95%CI -32.5 to 20.4) between the evaluation and control clinics.
  
  
  CONCLUSIONS
  In part due to a restrictive algorithm, Xpert as follow-on to smear microscopy did not increase the overall number of TB notifications, nor the number of bacteriologically positive cases.
authors.affiliation: School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: N B
authors.initials: NB
authors.lastname: Mbonze
authors.affiliation: School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: M
authors.initials: M
authors.lastname: Tabala
authors.affiliation: School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: L K
authors.initials: LK
authors.lastname: Wenzi
authors.affiliation: Provincial Coordination of the National TB Programme, Kinshasa, Democratic Republic of Congo.
authors.forename: B
authors.initials: B
authors.lastname: Bakoko
authors.affiliation: Public Health, TB and HIV Consult, Tilburg, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Brouwer
authors.affiliation: Stop TB Partnership, Secretariat, Geneva, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Creswell
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: A
authors.initials: A
authors.lastname: Van Rie
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: F
authors.initials: F
authors.lastname: Behets
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, USA.
authors.forename: M
authors.initials: M
authors.lastname: Yotebieng
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001431:Bacteriological Techniques; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries; D018563:Disease Notification; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000382:microbiology