Table 3.
TB cases diagnosed, bacteriologically confirmed TB and empiric treatment in reviewed citations*
| Author, reference | Publication year | Country | Design | Sample Size n | Settings | TB cases diagnosed/ bacteriologically confirmed TB/ empiric treatment | TB patients diagnosed using smear n | n (%) | TB patients diagnosed using Xpert n | n (%) or /100 000 | RR (95%CI) | P value |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Yoon27 | 2012 | Uganda | PC | 477 | In-patients | Bacteriologically confirmed TB† | 178 | 107 (60.0) | 125 | 82 (65.0) | — | NA |
| Empiric treatment‡ | 178 | 27 (15.0) | 125 | 9 (7.0) | — | 0.047 | ||||||
| TB cases diagnosed | 178 | 134 (75.0) | 125 | 98 (78.0) | — | 0.51 | ||||||
| Mupfumi25 | 2014 | Zimbabwe | RCT | 424 | Out-patients, HIV clinic at hospital | Empiric treatment | 45 | 31 (69) | 43 | 23 (54) | — | 0.120 |
| Trajman14 | 2015 | Brazil | CRT | 4 088 | In- and out-patients, clinic | Bacteriologically confirmed TB | 1 856 | 1 262 (68.0) | 2 232 | 1 701 (76.2) | — | <0.05 |
| Empiric treatment | 1 856 | 594 (32.0) | 2 232 | 531 (23.0) | — | NA | ||||||
| Agizew15 | 2015 | Botswana | CRT | 6 041 | Out-patients, HIV clinic | Bacteriologically confirmed TB | 35 | 8 (23.0) | 149 | 86 (58.0) | — | <0.001 |
| Calligaro22 | 2015 | South Africa | RCT | 341 | In-patients, hospitalized in intensive care unit | Bacteriologically confirmed TB | 16 | 6 (37.5) | 24 | 20 (83.3) | — | NA |
| Empiric treatment | 16 | 9 (56.0) | 24 | 4 (17.0) | — | 0.015 | ||||||
| Creswell29§ | 2015 | Nepal | PC | 14 846 | In- and out-patients, clinic | Bacteriologically confirmed TB | 5 123 | 3 390 (66.2) | 9 375 | 7 812 (83.3) | — | 0.001 |
| Van Den Handel30 | 2015 | South Africa | PC | 1 449 | In- and out-patients, clinic | Bacteriologically confirmed TB | 75 | 48 (64.0) | 123 | 114 (92.0) | 0.69 (0.58–0.82) | <0.001 |
The numerator and denominator of the number of TB patients for smear and Xpert groups were taken as published in the citations.
TB diagnosis based on bacteriological evidence of the presence of Mycobacterium tuberculosis complex.
The initiation of treatment in the absence of a bacteriologically confirmed diagnosis.17
Creswell et al. reported an 8.5% non-significant, lower than expected annual pulmonary TB notifications in the second year of intervention (Xpert introduction) compared with baseline (pre-intervention) TB notifications (4 589 vs. 5 123).29 Sachdeva et al. reported TB patients diagnosed per 100 000 among Xpert and smear (respectively 134/100 000 vs. 116/100 000 population; RR 1.16, P, 0.001).28
TB = tuberculosis; RR = risk ratio; CI = confidence interval; PC = prospective cohort; NA = not available; RCT =randomized clinical trial; HIV = human immunodeficiency virus; CRT =clustered randomized trial.