id	author	title	date	pages	extension	mime	words	sentence	flesch	summary	cache	txt
ajlm-1811	Williams, Victor; Calnan, Marianne; Edem, Bassey; Onwuchekwa, Chukwuemeka; Okoro, Chika; Candari, Christine; Cruz, Rhodora; Otwombe, Kennedy	GeneXpert rollout in three high-burden tuberculosis countries in Africa: A review of pulmonary tuberculosis diagnosis and outcomes from 2001 to 2019	2022		.htm	text/html	5469	282	48	However, the national programme did report an increase in tuberculosis case finding in those areas with access to Xpert.18 Additional studies on the utility of Xpert in Nigeria found that it increased tuberculosis case detection among smear-negative PTB patients.24 Implementation data from the South African National Health Laboratory services from 2011 to 2019 demonstrateed a declining trend in the number of cases detected.19 In a study to assess the impact of Xpert rollout on tuberculosis diagnostic yield and time to initiate therapy, the researchers observed marginal increases in tuberculosis case detection and time to initiate treatment, suggesting the need to address the health system to improve Xpert MTB/RIF efficiency.25 In a similar study, Xpert increased the proportion of rifampicin-resistant confirmed tuberculosis and significantly reduced the time to diagnosis, commencing therapy, and the pre-treatment mortality in patients with drug-resistant tuberculosis.26 However, on-treatment mortality and treatment outcomes did not change, reflecting a need to address treatment gaps and treatment outcomes.26 Similar to our findings, the Health Systems Trust (an organisation established to assist with the transformation of the healthcare system in South Africa) showed there has been an annual decline in tuberculosis incidence in South Africa from 2011 to 2015 and data from the University of KwaZulu-Natal suggest that the rapid drop in tuberculosis cases detected could be attributed partially to the scale-up of antiretroviral therapy that took place between 2009 and 2014.27,28,29 However, about 150 000 tuberculosis cases are missed annually in South Africa – nearly 50% of the tuberculosis burden in the country.30 Patient-side and health system-side factors may contribute to the missed cases and thus reduce the impact of Xpert on tuberculosis case detection and treatment outcomes.	cache/ajlm-1811.htm	txt/ajlm-1811.txt