Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 Mar;17(3):368-72.
doi: 10.5588/ijtld.12.0392.

Point-of-care Xpert® MTB/RIF for smear-negative tuberculosis suspects at a primary care clinic in South Africa

A Van Rie  1 , L Page-Shipp, C F Hanrahan, K Schnippel, H Dansey, J Bassett, K Clouse, L Scott, W Stevens, I Sanne
Affiliations
Comparative Study

Point-of-care Xpert® MTB/RIF for smear-negative tuberculosis suspects at a primary care clinic in South Africa

A Van Rie et al. Int J Tuberc Lung Dis. 2013 Mar.

Abstract

Objective: To assess the clinical utility and cost of point-of-care Xpert® MTB/RIF for the diagnosis of smear-negative tuberculosis (TB).

Design: Cohort study of smear-negative TB suspects at a South African primary care clinic. Participants provided one sputum sample for fluorescent smear microscopy and culture and an additional sample for Xpert. Outcomes of interest were TB diagnosis, linkage to care, patient and provider costs.

Results: Among 199 smear-negative TB suspects, 16 were positive by Xpert, 15 by culture and 7 by microscopy. All cases identified by Xpert began anti-tuberculosis treatment the same or next day; only one of five Xpert-negative culture-positive cases started treatment after 34 days. Xpert at point of care offered similar diagnostic yield but a faster turnaround time than smear and culture performed at a centralized laboratory. Compared to smear plus culture, Xpert (at US$9.98 per cartridge) was US$3 less expensive per valid result (US$21 vs. US$24) and only US$6 more costly per case identified (US$266 vs. US$260).

Conclusion: Xpert is an effective method of diagnosing smear-negative TB. It is cost saving for patients, especially if performed at point of care, but it is costly for health care providers. Data-driven studies are needed to determine its cost-effectiveness in resource-poor settings with diverse diagnostic practices.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: none declared.

References

    1. World Health Organization. A major milestone for tuberculosis diagnosis and care. Geneva, Switzerland: WHO; 2010. [Accessed November 2012]. WHO endorses new rapid tuberculosis test. http://www.who.int/mediacentre/news/releases/2010/tb_test20101208/en/ind....
    1. World Health Organization. WHO report 2009. Geneva, Switzerland: WHO; 2010. Global tuberculosis control: surveillance, planning, financing. WHO/HTM/TB/2009.411.
    1. Getahun H, Harrington M, O’Brien R, Nunn P. Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes. Lancet. 2007;369:2042–2049. - PubMed
    1. MacPherson P, Dimairo M, Bandason T, et al. Risk factors for mortality in smear-negative tuberculosis suspects: a cohort study in Harare, Zimbabwe. Int J Tuberc Lung Dis. 2011;15:1390–1396. - PMC - PubMed
    1. World Health Organization. Public-private partnership announces immediate 40 percent cost reduction for rapid TB test. Geneva, Switzerland: WHO; 2012. [Accessed January 2013]. http://www.who.int/tb/features_archive/GeneXpert_press_release_final.pdf.

Publication types

MeSH terms

Substances

LinkOut - more resources