How is Xpert MTB/RIF being implemented in 22 high tuberculosis burden countries?

Accurate and rapid diagnosis is crucial for tuberculosis control by ensuring a timely start to treatment and reducing transmission. In 2012, almost one third of tuberculosis cases were not diagnosed and/or reported to national tuberculosis programmes (NTPs), and <25% of estimated incident multidrug-resistant (MDR) cases were diagnosed [1]. Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA), a nucleic acid amplification test, was recommended in 2010 by the World Health Organization (WHO) for detection of HIV-associated pulmonary tuberculosis and rifampicin resistance [2]. In 2013, the test was recommended for detection of paediatric tuberculosis and some forms of extrapulmonary tuberculosis (EPTB), as well as an initial test to replace smear microscopy [3]. Xpert MTB/RIF implementation is mainly donor-funded, focused on DST and is not widely used outside South Africa We are grateful to all NTP staff and respondents who completed the surveys and answered our follow-up questions. We are also grateful to Claudia Denkinger (Foundation for Innovative New Diagnostics, Geneva, Switzerland), Sandra Kik (KNCV Tuberculosis Foundation, The Hague, The Netherlands) and Pamela Chedore (independent laboratory consultant, Toronto, Canada) for useful input on the survey design.