Countrywide roll-out of Xpert&lt;SUP&gt;®&lt;/SUP&gt; MTB/RIF in Swaziland: the first three years of implementation

Sikhondze, Welile; Dlamini, Themba; Khumalo, Derrick; Maphalala, Gugu; Dlamini, Sindi; Zikalala, T.; Albert, Heidi; Wambugu, Jesse; Tayler-Smith, K.; Ali, Engy; Adè, S.; Harries, Anthony

doi:10.5588/pha.15.0001

Cited by 23 publications

(40 citation statements)

References 10 publications

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“…Both Kenya and Swaziland have high rates of TB and HIV coinfection and MDR-TB [1]. Both countries were early adopters of Xpert MTB/RIF [19] [20] as the initial diagnostic test for all presumptive TB patients, based on the WHO recommended algorithm shown in Fig 1 [2]. Despite having similar diagnostic algorithms, access to Xpert MTB/RIF testing varies quite significantly with 26% and 82% of presumptive TB patients being tested by Xpert MTB/RIF in Kenya and Swaziland respectively [1].…”

Section: Settingmentioning

confidence: 99%

Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB/RIF Ultra in Kenya and Swaziland

et al. 2020

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Implementing new diagnostics in public health programs can involve difficult trade-off decisions between individual patient benefits and public health considerations. Such decisionmaking processes are often not documented and may not include engagement of affected communities. This paper examines the perspectives of stakeholders on the trade-off between over-treatment and missed diagnosis captured during decision-making workshops on the transition from use of Xpert MTB/RIF to diagnose tuberculosis to Xpert MTB/RIF Ultra in Kenya and Swaziland. Xpert MTB/RIF Ultra has an overall increase in sensitivity but a decrease in specificity when compared to its predecessor. We conducted a qualitative study using four focus group discussions with a total of 47 participants and non-participant observation. The analysis reveals how participants deemed Xpert MTB/RIF Ultra's reduced specificity vis-à-vis its increased sensitivity to be an acceptable trade-off. The way participants assessed this trade-off was shaped by their experiences with the general uncertainty of all diagnostic tests, alternative testing options, historical evolution of diagnostic practices, epidemiological factors and resource constraints. In assessing the trade-off community and individual benefit and harm was frequently discussed together. Qualitative research on stakeholder engagement activities for diagnostic development and implementation can identify everyday experiences and situate assessments and perspectives of key stakeholders and as such aid in decision-making, improving implementation as well as patient outcomes. Further research is needed on the intended and unintended consequences of such engagement activities, how findings are being incorporated by decision-makers, and the impact on programmatic implementation.

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Section: Settingmentioning

confidence: 99%

Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB/RIF Ultra in Kenya and Swaziland

et al. 2020

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“…19 The system of sending sputum specimens and receiving the results back between the peripheral health facilities and the central reference laboratory in Harare did not work. At each stage there were losses, and when the specimens finally did arrive at the laboratory, over half failed to successfully grow M. tuberculosis.…”

Section: Public Health Action Managing Rmp-resistant Tb In Zimbabwe 126mentioning

confidence: 99%

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert^® MTB/RIF in Zimbabwe

Charambira¹,

Adè

Harries

et al. 2016

public health action

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“…54 While significant strides have been made in scaling up and decentralising Xpert in various settings, operational issues still exist, and there is so far no evidence of impact on treatment outcomes or mortality. 55,56 More recently, the WHO has recommended second-line probe assays for detecting resistance to second-line anti-tuberculosis drugs. 57 The current expensive, toxic, 2-year treatment of MDR-TB is unacceptable and needs urgent change; shorter and less toxic regimens have shown promise and are now recommended by the WHO.…”

Section: Ending Tuberculosis Deathsmentioning

confidence: 99%

Ending tuberculosis by 2030: can we do it?

Suthar¹,

Zachariah²,

Harries³

2016

int j tuberc lung dis

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Countrywide roll-out of Xpert<SUP>®</SUP> MTB/RIF in Swaziland: the first three years of implementation

Cited by 23 publications

References 10 publications

Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB/RIF Ultra in Kenya and Swaziland

Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB/RIF Ultra in Kenya and Swaziland

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert^® MTB/RIF in Zimbabwe

Ending tuberculosis by 2030: can we do it?

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Countrywide roll-out of Xpert<SUP>®</SUP> MTB/RIF in Swaziland: the first three years of implementation

Cited by 23 publications

References 10 publications

Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB/RIF Ultra in Kenya and Swaziland

Situating trade-offs: Stakeholder perspectives on overtreatment versus missed diagnosis in transition to Xpert MTB/RIF Ultra in Kenya and Swaziland

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert® MTB/RIF in Zimbabwe

Ending tuberculosis by 2030: can we do it?

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Product

Resources

About

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert^® MTB/RIF in Zimbabwe