Schmidt 2017.

Study characteristics
Methods	Before and after evaluation cohort to evaluate impact of roll‐out of Xpert MTB/RIF on detection and treatment of adults with pulmonary tuberculosis
Participants	18 years old and above Adults suspected of pulmonary tuberculosis Female: 45.9% before, 44.1% after HIV infection was not reported Setting: primary health care in the Cape Winelands East in Weastern Cape. The Cape Winelands is a semi‐rural area with a very high estimated total tuberculosis case notification rate of 1400 per 100,000 population Country: South Africa Sample size: 15,629 before; 10,741 after
Interventions	Data were collected from the electronic NHLS database, which records all microbiological tests for tuberculosis in the region, including the type of test (sputum smear microscopy, Xpert MTB/RIF, or liquid culture), and the result of each test. Unique individuals tested for pulmonary tuberculosis were identified by unique laboratory identifiers. Data from the two periods were compared for the proportion of participants investigated for tuberculosis who tested positive by sputum smear microscopy, liquid culture, or Xpert MTB/RIF, and the proportion of sputum smear microscopy, liquid culture, or Xpert MRB/RIF tests that were positive.
Outcomes	Primary outcome: tuberculosis detection Secondary outcome: median time to diagnosis median time to treatment
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	A before‐after study, no randomization was done
Allocation concealment (selection bias)	High risk	A before‐after study, where allocation of intervention was not concealed; allocation was determined by calender period
Baseline characteristics similar (selection bias)	Low risk	No substantial differences observed
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding was done
Protection against contamination (performance bias)	Low risk	Data were extracted by specific test used, based on the unique laboratory identifier
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Data were available prior to the evaluation; outcome assessor unlikely to be blinded in routine care
Incomplete outcome data (attrition bias) All outcomes	Low risk	Missing data were similar before and after intervention, and not statistically different
Selective reporting (reporting bias)	Low risk	All outcomes stated in the methods were reported
Other bias	High risk	Risk of confounding due to before‐after design