Effects of Xpert MTB/RIF and alternative diagnostics for TB in Tanzania [0078]

Langley, I., Lin, H.H., Egwaga, S., Doulla, B., Ku, C.C., Murray, M., Cohen, T. and Squire, S.B., 2014. Assessment of the patient, health system, and population effects of Xpert MTB/RIF and alternative diagnostics for tuberculosis in Tanzania: an integrated modelling approach. The Lancet Global Health, 2(10), pp.e581-e591.

New diagnostic methods and algorithms could address weaknesses in current diagnostic processes but may increase resource and funding demands.

Full rollout of Xpert (B1) offers the greatest patient-level benefits among diagnostic options.

Xpert reduces the mean number of patient visits for diagnosis by 1.2 (95% CrI 1.1–1.3).

Time to start treatment decreases by 6.6 days (95% CrI 5.9–7.3) with Xpert.

Diagnostic loss to follow-up reduces by 7% (95% CrI 6–9), increasing successful diagnosis and treatment completion by 18%.

At the health-system level, full Xpert scale-up reduces required sputum samples by 34% (441,000 vs. 730,000 annually).

Xpert requires only 45% of the laboratory staff time compared to the base case.

Full Xpert rollout has the greatest epidemiological impact on reducing tuberculosis prevalence, mortality, and incidence.

Over 10 years, Xpert is projected to prevent 17,000 (95% CrI 8,800–26,600) tuberculosis cases and 39,700 (95% CrI 27,600–53,000) deaths.

New diagnostics also improve survival rates of tuberculosis and HIV co-infected patients, increasing ART access.

Three cost-effective strategies in Tanzania:

• Full Xpert MTB/RIF (B1) rollout at $169 per DALY averted.
• Same-day LED fluorescence microscopy (A3) at $45 per DALY averted.
• LED fluorescence microscopy (A2) at $29 per DALY averted.