Can the High Sensitivity of Xpert MTB/RIF Ultra Be Harnessed to Save Cartridge Costs? Results from a Pooled Sputum Evaluation in Cambodia
Abstract
:1. Introduction
2. Methods
2.1. Active Case Finding Setting
2.2. Pooling of Specimens and Ultra Testing
2.3. Data Management and Analysis
2.4. Ethical Approval
3. Results
3.1. Individual Test Results
3.2. Pooled Results
3.3. Cartridge Savings and Impact of CXR Screening on Costs
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Individuals Tested with Ultra | n = 584 | % | Individuals with Positive Ultra Results | n = 91 | % |
---|---|---|---|---|---|
Sex | Sex | ||||
Female | 295 | 50.5% | Female | 31 | 34% |
Male | 289 | 49.5% | Male | 60 | 66% |
Age | Age | ||||
<35 | 9 | 1.5% | <35 | 2 | 2.2% |
35<55 | 53 | 9.1% | 35<55 | 16 | 17.6% |
>55 | 522 | 89% | >55 | 71 | 78.0% |
Employment Status | Employment Status | ||||
Elderly/retired | 78 | 13.4% | Elderly/retired | 13 | 14.3% |
Factory worker | 2 | 0.3% | Farmer | 55 | 60.4% |
Farmer | 413 | 70.7% | Government officer | 2 | 2.2% |
Government officer | 9 | 1.5% | Unemployed | 12 | 13.2% |
Unemployed | 59 | 10.1% | Own business | 4 | 4.4% |
Own Business | 10 | 1.7% | Private company staff | 1 | 1.1% |
Private company staff | 1 | 0.2% | Seller | 4 | 4.4% |
Seller | 12 | 2.1% | |||
Symptom screen | Symptom Screen | ||||
Any symptom | 556 | 95.2% | Any symptom | 86 | 94% |
No symptoms | 28 | 4.8% | No symptoms | 5 | 5.5% |
Cough alone | 43 | 7.7% | Cough alone | 5 | 5.5% |
Chest X-ray (CXR) Results | CXR Results | ||||
CXR active | 115 | 19.7% | CXR active | 47 | 51.6% |
CXR presumptive Tuberculosis (TB) | 112 | 19.2% | CXR presumptive TB | 29 | 31.9% |
CXR healed | 45 | 7.7% | CXR healed TB | 13 | 14.3% |
CXR normal | 301 | 51.5% | CXR normal | 2 | 2.2% |
CXR other | 11 | 1.9% | |||
Other TB risk factors | Other TB risk factors | ||||
TB contact | 84 | 14.4% | TB contact | 17 | 18.7% |
PLHIV | 5 | 0.86% | PLHIV | 2 | 2.2% |
Diabetes | 34 | 5.8% | Diabetes | 10 | 11.0% |
Xpert MTB/RIF Ultra Result | Individual Results n = 584 | Pooled Results n = 153 | ||
---|---|---|---|---|
Negative (N) | 493 | 84.4% | 80 | 52.3% |
MTB with rifampicin resistance detected (RR) | 3 | 0.5% | 0 | 0% |
MTB with no rifampicin resistance detected (T) | 74 | 12.7% | 59 | 38.6% |
MTB with low rifampicin resistance detected (Ti) | 1 | 0.2% | 3 | 1.9% |
MTB trace detected (TT) | 13 | 2.2% | 11 | 7.2% |
Results from Pooled Testing | Results from Individual Testing | |||
---|---|---|---|---|
Total | MTB-Negative | MTB-Positive | ||
All pooled specimens | 153 | 584 | 493 (84.4%) | 91 (15.6%) |
MTB-Negative | 80 (52.3%) | 304 | 304 (100.0%) | 0 (0.0%) |
MTB-Positive | 73 (47.7%) | 280 | 189 (67.5%) | 91 (32.5%) |
RIF-Resistant MTB | 0 (0.0%) | - | - | 3 (3.3%) |
Pooled specimens with all CXR abnormal individuals | 66 | 253 | 175 (69.2%) | 78 (30.8%) |
MTB-Negative | 6 (9.1%) | 22 | 22 (4.5%) | 0 (0.0%) |
MTB-Positive | 60 (90.9%) | 231 | 153 (31.0%) | 78 (85.7%) |
RIF-Resistant MTB | 0 (0.0%) | - | - | 3 (3.3%) |
Pooled specimens with mixed CXR results | 17 | 64 | 55 (85.9%) | 9 (14.1%) |
MTB-Negative | 6 (35.3%) | 23 | 23 (4.7%) | 0 (0.0%) |
MTB-Positive | 11 (64.7%) | 41 | 30 (6.1%) | 11 (12.1%) |
RIF-Resistant MTB | 0 (0.0%) | - | - | 0 (0.0%) |
Pooled specimens with all CXR normal individuals | 70 | 267 | 265 (99.3%) | 2 (0.7%) |
MTB-Negative | 68 (97.1%) | 259 | 259 (52.5%) | 0 (0.0%) |
MTB-Positive | 2 (2.9%) | 8 | 6 (1.2%) | 2 (2.2%) |
RIF-Resistant MTB | 0 (0.0%) | - | - | 0 (0.0%) |
Total Cartridges Used | Cartridges Saved (%) | Total Time Required (Hours) | Time Saved (Hours) | Total Cost | Costs Saved (%) | |
---|---|---|---|---|---|---|
Individual approach | 584 | - | 876 | USD 6050 | ||
Pooled approach | 433 | 151 (27) | 650 | 226 | USD 4485 | 1565 (27) |
Hybrid approach * | 382 | 202 (35) | 573 | 300 | USD 3958 | 2092 (35) |
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Chry, M.; Smelyanskaya, M.; Ky, M.; Codlin, A.J.; Cazabon, D.; Tan Eang, M.; Creswell, J. Can the High Sensitivity of Xpert MTB/RIF Ultra Be Harnessed to Save Cartridge Costs? Results from a Pooled Sputum Evaluation in Cambodia. Trop. Med. Infect. Dis. 2020, 5, 27. https://doi.org/10.3390/tropicalmed5010027
Chry M, Smelyanskaya M, Ky M, Codlin AJ, Cazabon D, Tan Eang M, Creswell J. Can the High Sensitivity of Xpert MTB/RIF Ultra Be Harnessed to Save Cartridge Costs? Results from a Pooled Sputum Evaluation in Cambodia. Tropical Medicine and Infectious Disease. 2020; 5(1):27. https://doi.org/10.3390/tropicalmed5010027
Chicago/Turabian StyleChry, Monyrath, Marina Smelyanskaya, Mom Ky, Andrew J Codlin, Danielle Cazabon, Mao Tan Eang, and Jacob Creswell. 2020. "Can the High Sensitivity of Xpert MTB/RIF Ultra Be Harnessed to Save Cartridge Costs? Results from a Pooled Sputum Evaluation in Cambodia" Tropical Medicine and Infectious Disease 5, no. 1: 27. https://doi.org/10.3390/tropicalmed5010027