Summary of findings 1. Impact of Xpert MTB/RIF compared to smear microscopy.
| Impact of Xpert MTB/RIF compared to smear microscopy | ||||||
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Patient or population: people being investigated for tuberculosis (TB) Setting: primary healthcare clinics, specialized clinics, hospitals Intervention: Xpert MTB/RIF Comparison: smear microscopy | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with smear microscopy | Risk with Xpert MTB/RIF | |||||
| All‐cause mortality among participants | 5.9% | 5.3% (4.4 to 6.2) | RR 0.89 (0.75 to 1.05) | 9932 (5 RCTs) | ⊕⊕⊕⊝ Moderatea | Xpert MTB/RIF compared to smear microscopy probably does not increase mortality. We are uncertain whether there is a reduction in mortality or not with Xpert MTB/RIF. |
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All‐cause mortality at 6 months (subgroup) |
5.3% | 5.2% (4.1 to 6.5) | RR 0.98 (0.78 to 1.22) | 8143 (3 RCTs) | ⊕⊕⊕⊝ Moderatea | It is uncertain whether there is an effect of Xpert MTB/RIF compared with smear microscopy on mortality at 6 months. |
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All‐cause mortality in people who were HIV‐positive (subgroup) |
8.3% | 6.8% (5.7 to 8.0) | OR 0.80 (0.67 to 0.96) | 5855 (5 RCTs) | ⊕⊕⊕⊝ Moderatea |
Xpert MTB/RIF probably reduces mortality compared to smear microscopy in people who are HIV‐positive. |
| Successful treatment outcome in participants treated for tuberculosis | 70% | 72% (69 to 75) | OR 1.10 (0.95 to 1.26) | 4802 (3 RCTs) | ⊕⊕⊝⊝ Moderatea |
There are probably no fewer participants with a successful treatment outcome for Xpert MTB/RIF. We are uncertain if there is no effect or a modest increase. |
| Proportion of participants who were treated for tuberculosis | 20% | 22% (19.6 to 24.6) | RR 1.10 (0.98 to 1.23) | 8793 (5 RCTs) | ⊕⊕⊕⊝ Moderatea |
There are probably no fewer patients started on treatment with Xpert MTB/RIF. It is uncertain if there is no effect or a modest increase. |
| Pre‐treatment loss to follow‐up in participants with bacteriological confirmation | 14% | 8.3% (5.7 to 11.9) | RR 0.59 (0.41 to 0.85) | 1217 (3 RCTs) | ⊕⊕⊕⊝ Moderatea |
There are probably fewer patients lost after the test and before treatment is started with Xpert MTB/RIF than with smear microscopy. |
| Treated participants with bacteriological confirmation of tuberculosis | 50% | 72% (65 to 81) | RR 1.44 (1.29 to 1.61) | 2068 (6 RCTs) | ⊕⊕⊕⊝ Moderatea |
Of the participants started on TB treatment, probably more had a bacterial confirmation of TB with Xpert MTB/RIF than with smear microscopy |
| *The risk in the Xpert MTB/RIF group is based on the assumed risk in the comparison group and the relative effect of the intervention. The risk in the smear microscopy group was calculated from the total number of events and number of participants in the smear microscopy arms of the studies included in each analysis. CI: confidence interval; RR: risk ratio; OR: odds ratio; RCT: randomized controlled trial | ||||||
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GRADE Working Group certainty of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded by 1 for imprecision