Use of Xpert MTB/RIF in Decentralized Public Health Settings and Its Effect on Pulmonary TB and DR-TB Case Finding in India

Title: Use of Xpert MTB/RIF in Decentralized Public Health Settings and Its Effect on Pulmonary TB and DR-TB Case Finding in India
Authors: Sachdeva, KS
Raizada, N
Sreenivas, A
Van't Hoog, AH
Van den Hof, S
Dewan, PK
Thakur, R
Gupta, RS
Kulsange, S
Vadera, B
Babre, A
Gray, C
Parmar, M
Ghedia, M
Ramachandran, R
Alavadi, U
Arinaminpathy, N
Denkinger, C
Boehme, C
Paramasivan, CN
Item Type: Journal Article
Abstract: Background Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in high-burden settings. This study assessed the impact of up-front Xpert MTB/RIF testing on detection of pulmonary tuberculosis (PTB) and rifampicin-resistant PTB (DR-TB) cases in India. Methods This demonstration study was implemented in 18 sub-district level TB programme units (TUs) in India in diverse geographic and demographic settings covering a population of 8.8 million. A baseline phase in 14 TUs captured programmatic baseline data, and an intervention phase in 18 TUs had Xpert MTB/RIF offered to all presumptive TB patients. We estimated changes in detection of TB and DR-TB, the former using binomial regression models to adjust for clustering and covariates. Results In the 14 study TUs, which participated in both phases, 10,675 and 70,556 presumptive TB patients were enrolled in the baseline and intervention phase, respectively, and 1,532 (14.4%) and 14,299 (20.3%) bacteriologically confirmed PTB cases were detected. The implementation of Xpert MTB/RIF was associated with increases in both notification rates of bacteriologically confirmed TB cases (adjusted incidence rate ratio [aIRR] 1.39; CI 1.18-1.64), and proportion of bacteriological confirmed TB cases among presumptive TB cases (adjusted risk ratio (aRR) 1.33; CI 1.6-1.52). Compared with the baseline strategy of selective drug-susceptibility testing only for PTB cases at high risk of drug-resistant TB, Xpert MTB/RIF implementation increased rifampicin resistant TB case detection by over fivefold. Among, 2765 rifampicin resistance cases detected, 1055 were retested with conventional drug susceptibility testing (DST). Positive predictive value (PPV) of rifampicin resistance detected by Xpert MTB/RIF was 94.7% (CI 91.3-98.1), in comparison to conventional DST. Conclusion Introduction of Xpert MTB/RIF as initial diagnostic test for TB in public health facilities significantly increased case-notification rates of all bacteriologically confirmed TB by 39% and rifampicin-resistant TB case notification by fivefold.
Issue Date: 21-May-2015
Date of Acceptance: 23-Mar-2015
ISSN: 1932-6203
Publisher: Public Library of Science
Journal / Book Title: PLOS One
Volume: 10
Issue: 5
Copyright Statement: © 2015 Sachdeva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor/Funder: Medical Research Council (MRC)
Bill & Melinda Gates Foundation
Funder's Grant Number: MR/K010174/1B
Keywords: Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
Antitubercular Agents
Drug Resistance, Multiple, Bacterial
Geography, Medical
Microbial Sensitivity Tests
Molecular Diagnostic Techniques
Public Health Surveillance
Tuberculosis, Multidrug-Resistant
Tuberculosis, Pulmonary
General Science & Technology
MD Multidisciplinary
Publication Status: Published
Article Number: e0126065
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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