<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0213-9111</journal-id>
<journal-title><![CDATA[Gaceta Sanitaria]]></journal-title>
<abbrev-journal-title><![CDATA[Gac Sanit]]></abbrev-journal-title>
<issn>0213-9111</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS)]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0213-91112020000200006</article-id>
<article-id pub-id-type="doi">10.1016/j.gaceta.2019.02.010</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Will more sensitive diagnostics identify tuberculosis missed by clinicians? Evaluating Xpert MTB/RIF testing in Guatemala]]></article-title>
<article-title xml:lang="es"><![CDATA[¿Pueden las pruebas diagnósticas más sensibles identificar los casos de tuberculosis que se escapan a los clínicos? Evaluación de Xpert MIB/RIF en Guatemala]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Creswell]]></surname>
<given-names><![CDATA[Jacob]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Codlin]]></surname>
<given-names><![CDATA[Andrew J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oliva Flores]]></surname>
<given-names><![CDATA[Silvia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Samayoa]]></surname>
<given-names><![CDATA[Maritza]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramis]]></surname>
<given-names><![CDATA[Oriol]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Guardado]]></surname>
<given-names><![CDATA[Maria Elena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Stop TB Partnership  ]]></institution>
<addr-line><![CDATA[Geneva ]]></addr-line>
<country>Switzerland</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,The Task Force for Global Health Training Programs in Epidemiology and Public Health Interventions Network Guatemala Branch Office]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Guatemala</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Ministry of Health of Guatemala National Tuberculosis Program ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Guatemala</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,TB REACH Team Epirus ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2020</year>
</pub-date>
<volume>34</volume>
<numero>2</numero>
<fpage>127</fpage>
<lpage>132</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S0213-91112020000200006&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S0213-91112020000200006&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S0213-91112020000200006&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Objective To assess the impact of introducing Xpert as a follow-on test after smear microscopy on the total number pulmonary TB notifications.  Method Genexpert systems were installed in six departments across Guatemala, and Xpert was indicated as a follow-on test for people with smear-negative results. We analyzed notifications to national tuberculosis (TB) programmes (NTP) and the project's laboratory data to assess coverage of the intervention and case detection yield. Changes in quarterly TB notifications were analyzed using a simple pre/post comparison and a regression model controlling for secular notification trends. Using a mix of project and NTP data we estimated the theoretical yield of the intervention if testing coverage achieved 100%.  Results Over 18,000 smear-negative individuals were eligible for Xpert testing during the intervention period. Seven thousand, one hundred and ninety-three people (39.6% of those eligible) were tested on Xpert resulting in the detection of 199 people with smear-negative, Xpert positive results (2.8% positivity rate). In the year before testing began 1098 people with smear positive and 195 people with smear negative results were notified in the six intervention departments. During the intervention, smear-positive notification remained roughly stable (1090 individuals, 0.7%), but smear-negative notifications increased by 167 individuals (85.6%) to an all-time high of 362. After controlling for secular notifications trends over an eight-quarter pre-intervention period, combined pulmonary TB notifications (both smear positive and negative) were 19% higher than trend predictions. If Xpert testing coverage approached 100% of those eligible, we estimate there would have been a + 41% increase in TB notifications.  Conclusions We measured a large gain in pulmonary notifications through the introduction of Xpert testing alone. This indicates a large number of people with TB in Guatemala are seeking health care and being tested, yet are not diagnosed or treated because they lack bacteriological confirmation. Wider use of more sensitive TB diagnostics and/or improvements in the number of people clinically diagnosed with TB have the potential to significantly increase TB notifications in this setting, and potentially in other settings where a low proportion of pulmonary notifications are clinically diagnosed.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivo Evaluar el impacto en la notificación de casos de tuberculosis pulmonar de la introducción de Xpert como prueba de continuación después del análisis microscópico.  Método Se instalaron sistemas Genexpert es seis departamentos de Guatemala y se indicó como prueba consecutiva en todos los resultados negativos en la baciloscopia microscópica. Se analizaron los datos del Programa Nacional y los del laboratorio del proyecto para medir la cobertura y la productividad en detección de casos. Las notificaciones trimestrales se compararon con los valores anteriores a la intervención y se adoptó un modelo de regresión para controlar por las tendencias temporales. Se estimó la contribución teórica de la intervención en términos de notificación si se obtuviera una cobertura del 100%.  Resultados Durante el período de intervención, más de 18.000 personas con baciloscopia negativa fueron elegibles en los seis departamentos. El esputo de 7193 (36,9%) de ellos fue analizado también por Xpert y se detectaron 199 personas con baciloscopia negativa y Xpert positivo (positividad: 2,8%). En el año anterior a la intervención se notificaron 1098 casos de tuberculosis pulmonar y baciloscopia positiva, y 195 con baciloscopia negativa. Durante la intervención, la notificación de casos con baciloscopia positiva se mantuvo estable (1090 personas, 0,7%), pero las notificaciones con baciloscopia negativa, que incluía los casos con baciloscopia negativa y Xpert positivo, aumentó en 167 casos (85,6%), llegando a los 362 casos. Después de controlar por la tendencia temporal de notificación en los ocho trimestres anteriores, la notificación de tuberculosis pulmonar (con baciloscopia positiva o no) fue un 19% mayor que las predicciones de la tendencia. Si la cobertura de Xpert se acercase al 100%, se estima que se habría producido un incremento del 41% en las notificaciones.  Conclusiones Se identifica un importante aumento de las notificaciones de tuberculosis pulmonar solo con la introducción de Xpert. Ello indica que un número importante de personas con tuberculosis en Guatemala son atendidos por los servicios de salud y son sometidos a bacteriología microscópica, pero no son diagnosticados ni tratados porque no disponen de confirmación bacteriológica. La utilización de técnicas diagnósticas más sensibles o la mejora en el diagnóstico clínico tienen potencial para aumentar significativamente las notificaciones de tuberculosis pulmonar en esta zona y en cualquier otro lugar donde exista una proporción baja de diagnósticos clínicos no confirmados por microscopía.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Case detection]]></kwd>
<kwd lng="en"><![CDATA[Clinical diagnosis]]></kwd>
<kwd lng="en"><![CDATA[Xpert MTB/RIF]]></kwd>
<kwd lng="en"><![CDATA[Tuberculosis]]></kwd>
<kwd lng="en"><![CDATA[Laboratory]]></kwd>
<kwd lng="es"><![CDATA[Detección de casos]]></kwd>
<kwd lng="es"><![CDATA[Diagnóstico clínico]]></kwd>
<kwd lng="es"><![CDATA[Xpert MTB/RIF]]></kwd>
<kwd lng="es"><![CDATA[Tuberculosis]]></kwd>
<kwd lng="es"><![CDATA[Laboratorio]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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