PMID- 30598944
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220330
IS  - 2249-4863 (Print)
IS  - 2278-7135 (Electronic)
IS  - 2249-4863 (Linking)
VI  - 7
IP  - 5
DP  - 2018 Sep-Oct
TI  - A prospective study evaluating the impact of cartridge-based nucleic acid 
      amplification test (CBNAAT) on the management of tuberculosis in a low-resource 
      high-burden Indian rural setting.
PG  - 982-992
LID - 10.4103/jfmpc.jfmpc_104_18 [doi]
AB  - BACKGROUND: The cartridge-based nucleic acid amplification test (CBNAAT) Xpert 
      MTB/RIF is more sensitive than smear microscopy for the diagnosis of tuberculosis 
      (TB). It is also more expensive, costing 1450 INR as compared to 10 INR per 
      smear. OBJECTIVES: We conducted a prospective study to evaluate the impact of 
      CBNAAT results on patient management in our low-resource, high-burden Indian 
      rural setting. MATERIALS AND METHOD: Between February and July 2017, clinicians 
      were asked to complete one questionnaire at the time of CBNAAT request and 
      another when reviewing the result. The first questionnaire, "Form 1," concerned 
      pretest treatment status and asked clinicians to rate their confidence in the 
      diagnosis. "Form 2" concerned postresult treatment and investigation plan. 
      RESULTS: Over the study period, 206 CBNAATs were requested. Form 1 was not 
      completed for 85 patients and 21 were excluded leaving 100 in the main analysis. 
      MTB was detected (MTB-D) in 60 of 100 (60%) of samples tested. At the time of 
      CBNAAT request, 56 of 100 (56%) of patients were already on treatment, this being 
      empirical in 34 of 100 (34%). Despite this, 17 of 60 (28.3%) of MTB-D results 
      occurred in patients not yet started on treatment. Postresult treatment status 
      was available for 94 of 100 CBNAATs (55 MTB-D and 39 MTB-ND). Following an MTB-D 
      result, all 17 patients not on treatment started and all 38 on so already 
      continued. Following an MTB Not Detected (MTB-ND) result, 26 of 27 (96.3%) of 
      patients not yet on treatment remained so, but only 2 of 12 (16.7%) already on 
      treatment stopped. Even where the clinician's pretest confidence in TB was low, 
      9of 30 (30%) of CBNAAT results were MTB-D. CONCLUSION: In a low-resource 
      high-burden setting, CBNAAT may have greatest impact where the clinician's 
      pretest confidence in TB is low and empirical treatment has not been started. 
      This is because MTB-D results will lead to appropriate initiation of treatment 
      and MTB-ND results may enable clinicians to hold-off treatment.
FAU - Youngs, Jonathan
AU  - Youngs J
AD  - Jan Swasthya Sahyog (JSS) Health Centre, Ganiyari Village, Beltookri, 
      Chhattisgarh, India.
FAU - Patil, Sushil
AU  - Patil S
AD  - Jan Swasthya Sahyog (JSS) Health Centre, Ganiyari Village, Beltookri, 
      Chhattisgarh, India.
FAU - Jain, Yogesh
AU  - Jain Y
AD  - Jan Swasthya Sahyog (JSS) Health Centre, Ganiyari Village, Beltookri, 
      Chhattisgarh, India.
LA  - eng
PT  - Journal Article
PL  - India
TA  - J Family Med Prim Care
JT  - Journal of family medicine and primary care
JID - 101610082
PMC - PMC6259557
OTO - NOTNLM
OT  - CBNAAT MTB/RIF assay (geneCBNAAT)
OT  - Cartridge-based nucleic acid amplification test (CBNAAT)
OT  - Mycobacterium tuberculosis
OT  - PCR
OT  - point of care testing
COIS- There are no conflicts of interest.
EDAT- 2019/01/02 06:00
MHDA- 2019/01/02 06:01
PMCR- 2018/09/01
CRDT- 2019/01/02 06:00
PHST- 2019/01/02 06:00 [entrez]
PHST- 2019/01/02 06:00 [pubmed]
PHST- 2019/01/02 06:01 [medline]
PHST- 2018/09/01 00:00 [pmc-release]
AID - JFMPC-7-982 [pii]
AID - 10.4103/jfmpc.jfmpc_104_18 [doi]
PST - ppublish
SO  - J Family Med Prim Care. 2018 Sep-Oct;7(5):982-992. doi: 
      10.4103/jfmpc.jfmpc_104_18.