Comparing Tuberculosis Diagnostic Yield in Smear/Culture and Xpert® MTB/RIF-Based Algorithms Using a Non-Randomised Stepped-Wedge Design

Pren Naidoo, Rory Dunbar, Carl Lombard, Elizabeth du Toit, Judy Caldwell, Anne Detjen, S Bertel Squire, Donald A Enarson and Nulda Beyers

PLOS ONE, 2016, vol. 11, issue 3, 1-13

Abstract: Setting: Primary health services in Cape Town, South Africa. Study Aim: To compare tuberculosis (TB) diagnostic yield in an existing smear/culture-based and a newly introduced Xpert® MTB/RIF-based algorithm. Methods: TB diagnostic yield (the proportion of presumptive TB cases with a laboratory diagnosis of TB) was assessed using a non-randomised stepped-wedge design as sites transitioned to the Xpert® based algorithm. We identified the full sequence of sputum tests recorded in the electronic laboratory database for presumptive TB cases from 60 primary health sites during seven one-month time-points, six months apart. Differences in TB yield and temporal trends were estimated using a binomial regression model. Results: TB yield was 20.9% (95% CI 19.9% to 22.0%) in the smear/culture-based algorithm compared to 17.9% (95%CI 16.4% to 19.5%) in the Xpert® based algorithm. There was a decline in TB yield over time with a mean risk difference of -0.9% (95% CI -1.2% to -0.6%) (p

Date: 2016
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0150487

DOI: 10.1371/journal.pone.0150487

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