Population health impact and cost-effectiveness of tuberculosis diagnosis with Xpert MTB/RIF
[TB0037]
Menzies, N.A., Cohen, T., Lin, H.H., Murray, M. and Salomon, J.A., 2012. Population health impact and cost-effectiveness of tuberculosis diagnosis with Xpert MTB/RIF: a dynamic simulation and economic evaluation. PLoS medicine, 9(11), p.e1001347.
·
TB
diagnosis in high-burden settings mainly relies on sputum smear microscopy,
which has limited sensitivity, especially among HIV-infected patients.
·
Traditional
culture-based diagnosis and drug sensitivity testing are costly and slow, with
many resource-limited settings lacking the capacity for high-volume testing.
·
The
Xpert MTB/RIF automated DNA test provides rapid and sensitive detection of TB
and rifampicin resistance, using a cartridge-based system that integrates
sample processing and real-time PCR.
·
Xpert
can be used by relatively unskilled healthcare workers and delivers results in
less than 2 hours.
·
WHO
recommended Xpert for initial diagnosis in suspected cases of
multidrug-resistant TB (MDR-TB) or HIV-associated TB disease in December 2010.
·
Xpert
has the potential to significantly reduce TB morbidity and mortality,
especially in southern Africa, by diagnosing and enabling early treatment for
smear-negative TB cases.
·
Over
time, Xpert could reduce TB transmission and the reservoir of latent TB
infection in the population.
·
Despite
these benefits, TB incidence is projected to remain substantial after three
decades of Xpert use without other changes to TB control strategies.
·
This
persistence is due to the large pool of latently infected individuals and the
lower transmission likelihood of smear-negative cases diagnosed by Xpert.
· The adoption of Xpert increases demands on health systems, including the need for additional first-line TB treatment, HIV treatment for coinfected individuals, and second-line TB treatment for drug-resistant cases.
[Yoseph Leonardo Samodra]
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