Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2012 Sep 7;102(10):805-7. doi: 10.7196/samj.5851.
Xpert MTB/RIF (Xpert) offers rapid detection of Mycobacterium tuberculosis and rifampicin resistance. However, little is known about routine point-of-care (POC) use in high TB/HIV burden settings. We describe our experiences of launching Xpert as the POC, initial diagnostic for all TB suspects at a primary healthcare clinic in Johannesburg, South Africa. Noted important benefits of POC Xpert were fewer clinic visits, rapid detection of TB and rifampicin resistance, real-time assessment of accompanying household members of new TB cases, and increased staff motivation for TB screening. While Xpert results are available within 2 hours, actual turn-around time was longer for most patients because of sample preparation time and clinic congestion. Consequently, a GX4 instrument did not result in a 16-test capacity during an 8-hour working day, and some patients did not receive same-day results. Loss to follow-up was an unforeseen challenge, overcome by clinic flow changes, marking of clinic files, documenting patients' physical description and locating patients in the clinic by cell phone. Staff with high school education successfully performed the assay after minimal training. Human resource requirements were considerable, with a minimum of 2 staff needed to supervise sputum collection, process sputum, perform assays, and document results for an average of 15 TB suspects daily. POC placement of the instrument transferred logistical responsibilities to the clinic, including quality assurance, maintenance, stock control and cartridge disposal. POC use of Xpert is feasible at the primary healthcare level but must be accompanied by financial, operational and logistical support.
Xpert MTB/RIF（Xpert）可快速检测结核分枝杆菌和利福平耐药性。然而，在高结核/艾滋病毒负担环境中，关于常规即时护理点（POC）使用的信息却很少。我们介绍了在南非约翰内斯堡的一家初级保健诊所，将 Xpert 作为 POC 用于所有疑似结核病患者的初始诊断的经验。POC Xpert 的重要益处包括减少就诊次数、快速检测结核和利福平耐药性、实时评估新结核病病例的同住家庭成员、以及提高工作人员进行结核病筛查的积极性。虽然 Xpert 结果可在 2 小时内获得，但由于样本制备时间和诊所拥挤，大多数患者的实际周转时间更长。因此，即使配备了 GX4 仪器，在 8 小时工作日内也无法完成 16 次测试，而且有些患者无法当天获得结果。失访是一个意外的挑战，通过改变诊所流程、标记诊所档案、记录患者的身体描述以及通过手机在诊所定位患者来克服。经过最少的培训，具有高中教育背景的工作人员就能成功进行检测。人力资源需求相当大，每天平均需要 2 名工作人员来监督痰标本采集、处理痰标本、进行检测以及记录结果，以处理 15 名左右的疑似结核病患者。仪器的即时护理点放置将后勤责任转移到了诊所，包括质量保证、维护、库存控制和试剂盒处理。POC 即时护理点使用 Xpert 是可行的，但必须有财务、运营和后勤支持。
