Cargando…

Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India

INTRODUCTION: Xpert MTB/RIF was implemented in 2016 as the initial diagnostic test for extrapulmonary, pediatric, and human immunodeficiency virus–associated tuberculosis (TB) and as an add-on test for sputum microscopy–negative patients under Revised National TB Control Programme, Puducherry, India...

Descripción completa

Detalles Bibliográficos
Autores principales: Newtonraj, Ariarathinam, Venables, Emilie, Selvaraj, Kalaiselvi, Kundu, Debashish, Purty, Anil Jacob, Manikandan, Mani, Shewade, Hemant Deepak
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510069/
https://www.ncbi.nlm.nih.gov/pubmed/31143725
http://dx.doi.org/10.4103/jfmpc.jfmpc_421_18
_version_ 1783417371781758976
author Newtonraj, Ariarathinam
Venables, Emilie
Selvaraj, Kalaiselvi
Kundu, Debashish
Purty, Anil Jacob
Manikandan, Mani
Shewade, Hemant Deepak
author_facet Newtonraj, Ariarathinam
Venables, Emilie
Selvaraj, Kalaiselvi
Kundu, Debashish
Purty, Anil Jacob
Manikandan, Mani
Shewade, Hemant Deepak
author_sort Newtonraj, Ariarathinam
collection PubMed
description INTRODUCTION: Xpert MTB/RIF was implemented in 2016 as the initial diagnostic test for extrapulmonary, pediatric, and human immunodeficiency virus–associated tuberculosis (TB) and as an add-on test for sputum microscopy–negative patients under Revised National TB Control Programme, Puducherry, India. We intended to study the change in TB case notification rates (CNRs) after 2015 and explore the enablers and barriers for implementation of Xpert. MATERIALS AND METHODS: Sequential mixed-methods study, quantitative phase followed by a descriptive qualitative phase (key informant interviews with healthcare providers in the program). RESULTS: The TB (all forms) CNR increased in 2016 followed by a drop to 2015 levels in 2017. There was a reduction in patients notified as sputum-negative pulmonary TB and pediatric TB during 2016–2017. Healthcare providers used a negative Xpert result in ruling out TB among patients who would previously get diagnosed clinically. Perceived benefits of Xpert were efficiency, rapid results, and detecting resistance. Barriers included poor awareness among medical colleges and the private sector, difficulty in motivating sputum microscopy–negative patients for Xpert, and incompletely filled referral forms. CONCLUSION: Xpert-negative results should be interpreted cautiously after clinical assessment. Identified barriers should be addressed to ensure that all eligible undergo testing.
format Online
Article
Text
id pubmed-6510069
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-65100692019-05-29 Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India Newtonraj, Ariarathinam Venables, Emilie Selvaraj, Kalaiselvi Kundu, Debashish Purty, Anil Jacob Manikandan, Mani Shewade, Hemant Deepak J Family Med Prim Care Original Article INTRODUCTION: Xpert MTB/RIF was implemented in 2016 as the initial diagnostic test for extrapulmonary, pediatric, and human immunodeficiency virus–associated tuberculosis (TB) and as an add-on test for sputum microscopy–negative patients under Revised National TB Control Programme, Puducherry, India. We intended to study the change in TB case notification rates (CNRs) after 2015 and explore the enablers and barriers for implementation of Xpert. MATERIALS AND METHODS: Sequential mixed-methods study, quantitative phase followed by a descriptive qualitative phase (key informant interviews with healthcare providers in the program). RESULTS: The TB (all forms) CNR increased in 2016 followed by a drop to 2015 levels in 2017. There was a reduction in patients notified as sputum-negative pulmonary TB and pediatric TB during 2016–2017. Healthcare providers used a negative Xpert result in ruling out TB among patients who would previously get diagnosed clinically. Perceived benefits of Xpert were efficiency, rapid results, and detecting resistance. Barriers included poor awareness among medical colleges and the private sector, difficulty in motivating sputum microscopy–negative patients for Xpert, and incompletely filled referral forms. CONCLUSION: Xpert-negative results should be interpreted cautiously after clinical assessment. Identified barriers should be addressed to ensure that all eligible undergo testing. Medknow Publications & Media Pvt Ltd 2019-04 /pmc/articles/PMC6510069/ /pubmed/31143725 http://dx.doi.org/10.4103/jfmpc.jfmpc_421_18 Text en Copyright: © 2019 Journal of Family Medicine and Primary Care http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Newtonraj, Ariarathinam
Venables, Emilie
Selvaraj, Kalaiselvi
Kundu, Debashish
Purty, Anil Jacob
Manikandan, Mani
Shewade, Hemant Deepak
Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India
title Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India
title_full Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India
title_fullStr Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India
title_full_unstemmed Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India
title_short Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India
title_sort xpert negative means no tb: a mixed-methods study into early implementation of xpert in puducherry, india
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510069/
https://www.ncbi.nlm.nih.gov/pubmed/31143725
http://dx.doi.org/10.4103/jfmpc.jfmpc_421_18
work_keys_str_mv AT newtonrajariarathinam xpertnegativemeansnotbamixedmethodsstudyintoearlyimplementationofxpertinpuducherryindia
AT venablesemilie xpertnegativemeansnotbamixedmethodsstudyintoearlyimplementationofxpertinpuducherryindia
AT selvarajkalaiselvi xpertnegativemeansnotbamixedmethodsstudyintoearlyimplementationofxpertinpuducherryindia
AT kundudebashish xpertnegativemeansnotbamixedmethodsstudyintoearlyimplementationofxpertinpuducherryindia
AT purtyaniljacob xpertnegativemeansnotbamixedmethodsstudyintoearlyimplementationofxpertinpuducherryindia
AT manikandanmani xpertnegativemeansnotbamixedmethodsstudyintoearlyimplementationofxpertinpuducherryindia
AT shewadehemantdeepak xpertnegativemeansnotbamixedmethodsstudyintoearlyimplementationofxpertinpuducherryindia