Performance of Xpert MTB/RIF Ultra for tuberculosis diagnosis in the context of passive and active case finding
Por:
Saavedra, B, Mambuque, E, Nguenha, D, Gomes, N, Munguambe, S, Garcia, JI, Izco, S, Acacio, S, Murias-Closas, A, Cossa, M, Losada, I, Pernas-Pardavila, H, Oliveras, L, Theron, G, Garcia-Basteiro, AL
Publicada:
1 dic 2021
Resumen:
Aims We present a field evaluation of the diagnostic accuracy of Xpert MTB/RIF ("Xpert") and Xpert MTB/RIF Ultra ("Ultra") using two cohorts in a high tuberculosis/HIV burden setting in Southern Mozambique.
Methods Single respiratory specimens from symptomatic adults accessing healthcare services (passive case finding (PCF) cohort) and from household and community close contacts (active case finding (ACF) cohort) were tested by smear microscopy, culture, Xpert and Ultra. Liquid and solid culture served as a composite reference standard. We explored the impact of trace results on specificity via their recategorisation to negative (in all and just among those previously treated individuals).
Results 1419 and 252 participants were enrolled in the PCF and ACF cohorts, respectively. For the PCF cohort, Ultra showed higher sensitivity than Xpert overall (0.95 (95% CI 0.90-0.98) versus 0.88 (96% CI 0.82-0.93); p<0.001) and among smear-negative patients (0.84 (96% CI 0.71-0.93) versus 0.63 (96% CI 0.48-0.76)). Ultra's specificity was lower than Xpert's (0.96 (96% CI 0.95-0.97) versus 0.98 (96% CI 0.97-0.99); p=0.008). For ACF, sensitivities were the same (0.67 (95% CI 0.22-0.96) for both tests), although Ultra detected a higher number of microbiologically confirmed samples than Xpert (4.7% (12 out of 252) versus 2.7% (seven out of 252)). Conditional recategorisation of trace results among previously treated participants maintained differences in specificity in the PCF cohort.
Conclusion These results add evidence on the improved sensitivity of Ultra and support its use in different case finding scenarios.
Filiaciones:
Saavedra, B:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Hosp Clin Univ Barcelona, ISGlobal, Barcelona, Spain
Mambuque, E:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Nguenha, D:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Gomes, N:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Munguambe, S:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Garcia, JI:
Texas Biomed Res Inst, Populat Hlth Programme, TB Grp, San Antonio, TX USA
Izco, S:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Hosp Clin Univ Barcelona, ISGlobal, Barcelona, Spain
Acacio, S:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Murias-Closas, A:
Hosp Clin Univ Barcelona, ISGlobal, Barcelona, Spain
Cossa, M:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Losada, I:
Hosp Clin Univ Barcelona, ISGlobal, Barcelona, Spain
Pernas-Pardavila, H:
Complexo Hosp Univ Santiago, Infect Dis, Santiago De Compostela, Spain
Oliveras, L:
Hosp Clin Univ Barcelona, ISGlobal, Barcelona, Spain
Agencia Salut Publ Barcelona, Barcelona, Spain
Inst Invest Biomed St Pau IIB St Pau, Barcelona, Spain
Theron, G:
Stellenbosch Univ, Fac Med & Hlth Sci, DSI NRF Ctr Excellence Biomed TB Res, Div Mol Biol & Human Genet, Tygerberg, South Africa
Stellenbosch Univ, Fac Med & Hlth Sci, SAMRC Ctr TB Res, Div Mol Biol & Human Genet, Tygerberg, South Africa
Garcia-Basteiro, AL:
Ctr Invest Saude Manh CISM, Maputo, Mozambique
Hosp Clin Univ Barcelona, ISGlobal, Barcelona, Spain
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