Results from early programmatic implementation of Xpert MTB/RIF testing in nine countries

Area of Science:

• Microbiology
• Infectious Diseases
• Public Health

Background:

• The Xpert MTB/RIF assay is a promising tool for rapid tuberculosis diagnosis.
• Existing literature primarily focuses on controlled study conditions, with limited data on real-world implementation for routine case finding.
• TB REACH initiatives aim to innovate tuberculosis case notification strategies.

Purpose of the Study:

• To evaluate the real-world performance and implementation of the Xpert MTB/RIF assay in TB REACH projects.
• To analyze patient yields, rifampicin resistance detection, and operational challenges.
• To bridge the gap between research findings and practical application of MTB/RIF testing.

Main Methods:

• Convenience sampling of nine TB REACH projects across diverse settings.
• Analysis of quarterly reports and machine data (September 2011-March 2013) for test yields, resistance, and failure rates.
• Qualitative data collection via questionnaires and interviews with project staff regarding user experiences.

Main Results:

• Over 47,000 MTB/RIF tests were conducted, with 16.8% positive for Mycobacterium tuberculosis (MTB).
• 13.6% of MTB-positive tests indicated rifampicin resistance; 10.6% of all tests failed.
• Key implementation challenges included consistent power supply needs and heterogeneous data reporting practices.

Conclusions:

• Xpert MTB/RIF testing successfully identified numerous TB cases missed by routine services.
• The assay demonstrates versatility and impact in programmatic settings, despite implementation barriers.
• Findings highlight surmountable challenges and diverse approaches to implementing MTB/RIF testing in real-world scenarios.