The patient impact of point-of-care vs. Laboratory placement of XpertW MTB/RIF

Colleen Hanrahan, K. Clouse, J. Bassett, L. Mutunga, K. Selibas, W. Stevens, L. Scott, I. Sanne, A. Van Rie

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The Xpertw MTB/RIF assay can diagnose tuberculosis (TB) rapidly and with great accuracy. The effect of Xpert placement at point of care (POC) vs. at an off-site laboratory on patient management remains unknown. DESIGN : At a primary care clinic in Johannesburg, South Africa, we compared TB diagnosis and treatment initiation among 1861 individuals evaluated for pulmonary TB using Xpert performed either at POC or offsite. RESULT S : When Xpert was performed at POC, a higher proportion of Xpert-positive individuals started treatment (95% vs. 87%<P = 0.047) and time to treatment initiation was shorter (median 0 vs. 5 days, P <0.001). In contrast, among Xpert-negative TB cases, a higher proportion (87% vs. 72%<P=0.001) started treatment when the sample was sent to the laboratory, with a shorter time to treatment (median 9 vs. 13 days, P = 0.056). While the overall proportion of presumed TB patients starting treatment was independent of Xpert placement, the proportion started based on a bacteriologically confirmed diagnosis was higher when Xpert was performed at POC (73% vs. 58% <P = 0.006). CONCLUSIONS: Placement of Xpert at POC resulted in more Xpert-positive patients receiving treatment, but did not increase the total number of presumed TB patients starting treatment. When samples were sent to a laboratory for Xpert testing, empiric decision making increased.

Original languageEnglish (US)
Pages (from-to)811-816
Number of pages6
JournalInternational Journal of Tuberculosis and Lung Disease
Volume19
Issue number7
DOIs
StatePublished - Jul 1 2015

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Point-of-Care Systems
Tuberculosis
Therapeutics
South Africa
Pulmonary Tuberculosis
Primary Health Care
Decision Making

Keywords

  • Diagnostics
  • South Africa
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

The patient impact of point-of-care vs. Laboratory placement of XpertW MTB/RIF. / Hanrahan, Colleen; Clouse, K.; Bassett, J.; Mutunga, L.; Selibas, K.; Stevens, W.; Scott, L.; Sanne, I.; Van Rie, A.

In: International Journal of Tuberculosis and Lung Disease, Vol. 19, No. 7, 01.07.2015, p. 811-816.

Research output: Contribution to journalArticle

Hanrahan, C, Clouse, K, Bassett, J, Mutunga, L, Selibas, K, Stevens, W, Scott, L, Sanne, I & Van Rie, A 2015, 'The patient impact of point-of-care vs. Laboratory placement of XpertW MTB/RIF', International Journal of Tuberculosis and Lung Disease, vol. 19, no. 7, pp. 811-816. https://doi.org/10.5588/ijtld.15.0013
Hanrahan, Colleen ; Clouse, K. ; Bassett, J. ; Mutunga, L. ; Selibas, K. ; Stevens, W. ; Scott, L. ; Sanne, I. ; Van Rie, A. / The patient impact of point-of-care vs. Laboratory placement of XpertW MTB/RIF. In: International Journal of Tuberculosis and Lung Disease. 2015 ; Vol. 19, No. 7. pp. 811-816.
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