Venn diagram of yield per test and combinational yield of different TB diagnostic tests.

<p>Venn diagram of yield per test and combinational yield of different TB diagnostic tests.</p

Incremental sensitivities when Xpert MTB/RIF and LJ are used selectively in the general population.

<p>Strategy Key: 1- Fronting Microscopy, 2- Fronting Xpert MTB/RIF, 3- Microscopy followed by Xpert MTB/RIF, 4- Xpert MTB/RIF followed by LJ Culture, 5- Microscopy, followed by Xpert MTB/RIF followed by LJ.</p

Demographic characteristics of the study participants (n = 1,083).

<p>Demographic characteristics of the study participants (n = 1,083).</p

Accuracy of different Xpert MTB/Rif implementation strategies in programmatic settings at the regional referral hospitals in Uganda: Evidence for country wide roll out

<div><p>Background</p><p>Xpert MTB/RIF assay is a highly sensitive test for TB diagnosis, but still costly to most low-income countries. Several implementation strategies instead of frontline have been suggested; however with scarce data. We assessed accuracy of different Xpert MTB/RIF implementation strategies to inform national roll-out.</p><p>Methods</p><p>This was a cross-sectional study of 1,924 adult presumptive TB patients in five regional referral hospitals of Uganda. Two sputum samples were collected, one for fluorescent microscopy (FM) and Xpert MTB/RIF examined at the study site laboratories. The second sample was sent to the Uganda Supra National TB reference laboratory for culture using both Lowenstein Jensen (LJ) and liquid culture (MGIT). We compared the sensitivities of FM, Xpert MTB/RIF and the incremental sensitivity of Xpert MTB/RIF among patients negative on FM using LJ and/or MGIT as a reference standard.</p><p>Results</p><p>A total 1924 patients were enrolled of which 1596 (83%) patients had at least one laboratory result and 1083 respondents had a complete set of all the laboratory results. A total of 328 (30%) were TB positive on LJ and /or MGIT culture. The sensitivity of FM was n (%; 95% confidence interval) 246 (63.5%; 57.9–68.7) overall compared to 52 (55.4%; 44.1–66.3) among HIV positive individuals, while the sensitivity of Xpert MTB/RIF was 300 (76.2%; 71.7–80.7) and 69 (71.6%; 60.5–81.1) overall and among HIV positive individuals respectively. Overall incremental sensitivity of Xpert MTB/RIF was 60 (36.5%; 27.7–46.0) and 20 (41.7%; 25.5–59.2) among HIV positive individuals.</p><p>Conclusion</p><p>Xpert MTB/RIF has a higher sensitivity than FM both in general population and HIV positive population. Xpert MTB/RIF offers a significant increase in terms of diagnostic sensitivity even when it is deployed selectively i.e. among smear negative presumptive TB patients. Our results support frontline use of Xpert MTB/RIF assay in high HIV/TB prevalent countries. In settings with limited access, mechanisms to refer smear negative sputum samples to Xpert MTB/RIF hubs are recommended.</p></div

Incremental sensitivities when Xpert MTB/RIF and LJ are used selectively in the HIV positive population.

<p>Strategy: 1- Fronting Microscopy, 2- Fronting Xpert MTB/RIF, 3- Microscopy followed by Xpert MTB/RIF, 4- Xpert MTB/RIF followed by LJ Culture, 5- Microscopy, followed by Xpert MTB/RIF followed by LJ.</p

Flow chart of patients with laboratory complete results.

<p>Flow chart of patients with laboratory complete results.</p

Diagnostic accuracy of smear and Xpert MTB/RIF among the MGIT and/or LJ culture positive (n = 328) tuberculosis participants.

<p>Diagnostic accuracy of smear and Xpert MTB/RIF among the MGIT and/or LJ culture positive (n = 328) tuberculosis participants.</p

Global RECHARGE: Establishing a standard international data set for pulmonary rehabilitation in low- and middle-income countries

Chronic respiratory diseases (CRD) are highly prevalent in low- and middle-income countries (LMICs). People living with CRD are often disabled by breathlessness which can result in reduced health-related quality of life, including reduced exercise tolerance, significant psychological morbidity and reduced ability to work. Implementing clinically and cost-effective interventions to tackle these problems can be challenging in low-resource settings. Pulmonary rehabilitation is a low cost, high impact intervention that reverses CRD-related disability and is supported by the highest level of re-search. Pulmonary rehabilitation is delivered by a multidisciplinary team and has exercise training and education at its core to support effective disease management and improve people’s quality of life. There is an unmet need for pulmonary rehabilitation that is profound in LMICs where the demand greatly outweighs the capacity. The sparse existence of pulmonary rehabilitation in LMICs offers an important opportunity to support the expansion of high quality, benchmarked services as it becomes increasingly recognised and available. Quality assurance procedures for pulmonary rehabilitation in the developed world are now in place; helping to ensure a high standard of patient care. In this paper we discuss a common data set that has been developed by the NIHR Global Health Research Group on Respiratory Rehabilitation (Global RECHARGE). Standardising data collection with a pre-determined set of measurements is proposed whereby collaborators will use common data col-lection tools and procedures. Benchmarking and quality improvement with continuous audit offer a potential to maximise benefits, reduce waste and improve patient outcomes. We welcome expressions of interest from health care professionals and researchers from LMICs, including groups looking to strengthen their local research capacity and from those looking to set up pulmonary rehabilitation through to those already running a service. We believe the wide adoption of this core data set will facilitate quality assurance of pulmonary rehabilitation programmes, provide opportunities to expand services over time, de novo research opportunities offered by trans-national data and enhanced research capacity in partner organisations