Theron et al. (2014)
University of Cape Town, South Africa
Conducted at:
Five primary healthcare facilities in areas with a high HIV prevalence in South Africa, Zimbabwe and Tanzania
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Randomised controlled trial (multicentre)
Level: II
Quality: 23/26
Low risk of bias
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N=1,502
Median age: 37 years (IQR 30–46), 643 (43%) females, 895 (60%) HIV infected
758 assigned to AFB microscopy
744 assigned to Xpert MTB/RIF
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Inclusion:
> 17 years of age, one or more symptoms of pulmonary TB (according to WHO criteria), able to provide sputum specimens, no anti-TB treatment in past 60 days
Exclusion:
Not reported
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Xpert MTB/RIF on sputum specimen by nurse who received a 1-day training session
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AFB microscopy on sputum specimen Positive if any smear revealed AFB over 100 fields (1000x for light microscopy and 400x for fluorescence microscopy)
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TB-related morbidity after 2 and 6 months (using TBscore and Karnofsky performance score)
Mortality at 6-month follow-up
Failure rates
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Yoon et al. (2012)
Division of Pulmonary and Critical care Medicine, San Francisco General Hospital, University of San Francisco, San Francisco, California, USA
Conducted at:
Mulago Hospital, Kampala, Uganda
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Historical cohort study
Level: III-3
Quality: 18.5/26
Some risk of bias
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N=477/525 included
Median age: 33 years (IQR 27–40), 229 (48%) female, 362 (76%) HIV infected
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Inclusion:
Consecutive adults > 17 years of age admitted to hospital with cough > 2 weeks but < 6 months duration and provided consent
Exclusion:
Receiving TB treatment at the time of enrolment, no available culture results, no NAAT on implementation phase, death within 3 days of hospital admission
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GeneXpert MTB/RIF, sputum AFB microscopy and mycobacterial culture
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Same tests, but in comparator group Xpert results were not reported to clinicians or used for patient management
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2-month mortality
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