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Open Access Evaluation of the implementation of the Xpert® MTB/RIF assay in Fiji

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Setting: All Xpert® MTB/RIF tests performed in the three TB (tuberculosis) treatment centres in Fiji from June 2012 to February 2013.

Objectives: To determine 1) the number of Xpert tests performed in each centre, 2) the association between sputum quality and Xpert results, 3) the agreement of Xpert with acid-fast bacilli (AFB) smear microscopy and TB culture and 4) error rates.

Design: Retrospective review of records.

Results: A total of 415 Xpert tests were performed in the study period. Mycobacterium tuberculosis was detected in 69 (16.6%) samples. No rifampicin resistance was detected. M. tuberculosis was detected from 60 (18.7%) good-quality sputum samples. A total of 43 (10.4%) errors occurred during this period. M. tuberculosis was detected in 10 (2.9%) smear-negative specimens. There was a substantial and an almost perfect agreement between Xpert and AFB microscopy (κ = 0.793) and culture results (κ = 0.818), respectively.

Conclusion: Although a good correlation between Xpert and the two tests were shown in the study, Xpert should not replace the routine first-line TB diagnostic tests used in Fiji for reasons related to logistics and sustainability. A further evaluation of the assay's performance is required over a longer time period to gauge its diagnostic value in detecting smear-negative, Xpert-positive cases in Fiji.
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Keywords: Mycobacterium tuberculosis; Xpert® MTB/RIF; evaluation; rifampicin

Document Type: Research Article

Affiliations: 1: National Tuberculosis Program, Ministry of Health, Suva, Fiji 2: School of Population Health, The University of Queensland, Brisbane, Queensland, Australia

Publication date: September 21, 2014

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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