Van Den Handel T., Hampton K.H., Sanne I., Stevens W., Crous R., Van Rie A.
Right to Care, Johannesburg, South Africa; Department of Epidemiology, University of North Carolina Gillings, School of Global Public Health, Chapel Hill, NC, United States; Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; Department of Molecular Medicine and Hematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Services, Johannesburg, South Africa; Rural Districts, Western Cape Department of Health, Cape Town, South Africa; Right to Care, Western Cape, P O Box 54 Plettenberg Bay, Western Cape, South Africa
Van Den Handel, T., Right to Care, Johannesburg, South Africa, Right to Care, Western Cape, P O Box 54 Plettenberg Bay, Western Cape, South Africa; Hampton, K.H., Department of Epidemiology, University of North Carolina Gillings, School of Global Public Health, Chapel Hill, NC, United States; Sanne, I., Right to Care, Johannesburg, South Africa, Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; Stevens, W., Department of Molecular Medicine and Hematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, National Health Laboratory Services, Johannesburg, South Africa; Crous, R., Rural Districts, Western Cape Department of Health, Cape Town, South Africa; Van Rie, A., Department of Epidemiology, University of North Carolina Gillings, School of Global Public Health, Chapel Hill, NC, United States
Background: The impact of implementing Xpert® MTB/RIF and the choice of instrument placement on patient care in sparsely populated areas with poor access to laboratory and radiology services have not yet been elucidated. Methods: Prospective evaluation of three diagnostic approaches in the Central Karoo, South Africa: smear microscopy as the initial diagnostic, with sputum processing at centralised laboratories, and Xpert as the initial diagnostic with instrument placement at facility level or centralised laboratory. Results: Of 1449 individuals, 196 were diagnosed with TB. The proportion positive on initial testing was respectively 8%, 20% and 8% during the smear microscopy, decentralised Xpert and centralised Xpert periods. The proportion of bacteriologically confirmed cases was respectively 88%, 99% and 91% during the smear microscopy, decentralised Xpert and centralised Xpert periods. The median time to treatment was respectively 11.5 (interquartile range [IQR] 6-24), 1 (IQR 0-2) and 6 days (IQR 2-9) during the smear microscopy, decentralised Xpert and centralised Xpert periods. Conclusion: Introducing Xpert as the initial diagnostic in areas with poor access to TB diagnostics increased the proportion of cases with bacteriological confirmation and reduced time to treatment initiation; however, point-of-care placement may have resulted in fewer people being evaluated for TB. © 2015 The Union.