Creswell J, Rai B, Wali R, Sudrungrot S, Adhikari L M, Pant R, Pyakurel S, Uranw D, Codlin A J
Stop TB Partnership, Geneva, Switzerland.
Migration Health Department, International Organization for Migration, Kathmandu, Nepal.
Int J Tuberc Lung Dis. 2015 May;19(5):545-51. doi: 10.5588/ijtld.14.0775.
The Xpert(®) MTB/RIF assay is a highly sensitive molecular test with the potential to improve tuberculosis (TB) case detection. However, evidence supporting this potential at a programme level is minimal.
Xpert testing following smear microscopy and chest X-ray was implemented as part of routine case finding in 16 districts of Eastern Nepal. Changes in TB case notification were evaluated based on a pre/post analysis, as were expected notifications based on linear trend.
A total of 9723 Xpert tests were performed, resulting in the identification of 1662 Mycobacterium tuberculosis-positive patients. Despite a previous declining trend in notifications, annual bacteriologically positive TB notifications increased by 15.2% during the intervention, from 3390 to 3906. However, annual notifications of pulmonary TB dropped by 8.5% overall, from 5123 to 4688. Both observations were significantly different from expected notifications based on historical trends. Treatment initiation for drug-resistant TB almost doubled.
Xpert testing significantly increased bacteriologically positive TB notifications, but large reductions in empiric treatment of smear-negative disease reduced the number of pulmonary TB notifications overall. While better diagnostics remain critical, focusing solely on superior test sensitivity may not increase TB case notifications. Additional interventions are required to reach the millions of people with TB who are missed by routine services.
Xpert（®）MTB/RIF检测是一种高度灵敏的分子检测方法，具有改善结核病（TB）病例发现的潜力。然而，在项目层面支持这一潜力的证据很少。
在尼泊尔东部16个地区，将涂片显微镜检查和胸部X线检查后的Xpert检测作为常规病例发现的一部分实施。基于前后分析评估结核病病例通报的变化，基于线性趋势评估预期通报。
共进行了9723次Xpert检测，鉴定出1662例结核分枝杆菌阳性患者。尽管此前通报呈下降趋势，但在干预期间，细菌学确诊的结核病年度通报增加了15.2%，从3390例增至3906例。然而，肺结核的年度通报总体下降了8.5%，从5123例降至4688例。这两项观察结果均与基于历史趋势的预期通报有显著差异。耐多药结核病的治疗启动率几乎翻了一番。
Xpert检测显著增加了细菌学确诊的结核病通报，但涂片阴性疾病经验性治疗的大幅减少总体上降低了肺结核通报的数量。虽然更好的诊断仍然至关重要，但仅关注检测的卓越敏感性可能不会增加结核病病例通报。需要采取额外的干预措施，以覆盖常规服务遗漏的数百万结核病患者。
