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Home / Public Health Action, Volume 12, Number 2

Open Access Impact of on-site Xpert on TB diagnosis and mortality trends in Uganda

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SETTING: Since 2012, Uganda expanded the Xpert® MTB/RIF network for diagnosis of TB.

OBJECTIVES: We compared TB care cascades at health facilities with on-site Xpert vs. facilities that accessed the assay through specimen referral.

DESIGN: We analysed secondary aggregate data of the National TB and Leprosy Program (NTLP) from 2016 to 2019. We computed the proportions of notified TB cases and mortality ratios in relation to the estimated TB burden.

RESULTS: TB case notifications per annum increased from 24,287 in 2016 to 30,739 in 2019, and the proportion of cases diagnosed at facilities with on-site Xpert testing increased from 62% (15,070/24,287) to 81% (24,829/30,739) (P < 0.001). TB mortality at facilities with on-site Xpert decreased from 8.6% (1,302/15,070) to 7.8% (1,938/24,829) (P = 0.41), while it increased at facilities without on-site Xpert from 6.9% (638/9,217) to 8.8% (521/5,910) (P = 0.23). Furthermore, mortality among TB-HIV co-infected patients at facilities with on-site Xpert dropped from 5.0% (760/15,070) in 2016 to 4.8% (1,187/24,826) in 2019 (P = 0.84) compared to 4.4% (407/9,217) in 2016 to 5.3% (315/5,910) in 2019 (P = 0.57).

CONCLUSION: Wider installation and decentralisation of Xpert leads to increased case-finding. However, the impact on reduction in mortality remains limited. Interventions to address TB-related mortality in addition to Xpert roll-out are required.

Keywords: Uganda; Xpert MTB/RIF assay; cascade; impact; tuberculosis

Document Type: Research Article

Affiliations: 1: Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda, Makerere University Lung Institute, College of Health Sciences, Kampala, Uganda 2: Makerere University Lung Institute, College of Health Sciences, Kampala, Uganda 3: Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda 4: National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Uganda 5: Makerere University School of Public Health Monitoring and Evaluation Technical Support (METS) Program Uganda, Kampala, Uganda

Publication date: June 21, 2022

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

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