Gabriel M Cohen1, Paul K Drain, Farzad Noubary, Christie Cloete, Ingrid V Bassett. 1. *Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA; ‡Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA; §Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; ‖The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; ¶Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA; #McCord Hospital, Durban, KwaZulu-Natal, South Africa; and **Center for AIDS Research, Harvard Medical School, Boston, MA.
Abstract
SETTING: We conducted a retrospective study among HIV-infected adult suspects (≥18 years) with pulmonary tuberculosis (TB), who underwent Xpert MTB/RIF (Xpert) testing at McCord Hospital and its adjoining HIV clinic in Durban, South Africa. OBJECTIVE: To determine if Xpert testing performed at a centralized laboratory accelerated time to TB diagnosis. DESIGN: We obtained data on sputum smear microscopy [acid-fast bacilli (AFB)], Xpert, and the rationale for treatment initiation from medical records. The primary outcome was "total diagnostic time," defined as time from sputum collection to clinicians' receipt of results. A linear mixed-effect model compared the duration of steps in the diagnostic pathway across testing modalities. RESULTS: Among 403 participants, the median "total diagnostic time" for AFB and Xpert was 3.3 and 6.4 days, respectively (P < 0.001). When compared with AFB, the median delay for Xpert "laboratory processing" was 1.4 days (P < 0.001) and "result transfer to clinic" was 1.7 days (P < 0.001). Among 86 Xpert-positive participants who initiated treatment, 49 (57%) started treatment based on clinical suspicion or AFB-positive results, whereas only 32 (37%) started treatment based on Xpert-positive results. CONCLUSIONS: In our setting, Xpert results took twice as long as AFB results to reach clinicians. Replacing AFB with centralized Xpert may delay TB diagnoses in some settings.
SETTING: We conducted a retrospective study among HIV-infected adult suspects (≥18 years) with pulmonary tuberculosis (TB), who underwent Xpert MTB/RIF (Xpert) testing at McCord Hospital and its adjoining HIV clinic in Durban, South Africa. OBJECTIVE: To determine if Xpert testing performed at a centralized laboratory accelerated time to TB diagnosis. DESIGN: We obtained data on sputum smear microscopy [acid-fast bacilli (AFB)], Xpert, and the rationale for treatment initiation from medical records. The primary outcome was "total diagnostic time," defined as time from sputum collection to clinicians' receipt of results. A linear mixed-effect model compared the duration of steps in the diagnostic pathway across testing modalities. RESULTS: Among 403 participants, the median "total diagnostic time" for AFB and Xpert was 3.3 and 6.4 days, respectively (P < 0.001). When compared with AFB, the median delay for Xpert "laboratory processing" was 1.4 days (P < 0.001) and "result transfer to clinic" was 1.7 days (P < 0.001). Among 86 Xpert-positive participants who initiated treatment, 49 (57%) started treatment based on clinical suspicion or AFB-positive results, whereas only 32 (37%) started treatment based on Xpert-positive results. CONCLUSIONS: In our setting, Xpert results took twice as long as AFB results to reach clinicians. Replacing AFB with centralized Xpert may delay TB diagnoses in some settings.
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