The feasibility, accuracy and impact of XXXX testing in a remote Aboriginal community in Canada.

@entity1 @entity1906 @entity14275
Background: @entity14275 testing is being used extensively in countries with a high burden of @entity1906 . However recent evidence suggests that it may not have the same accuracy or impact in high-income, low-burden @entity1906 countries. Methods: A prospective, pragmatic study was done between March 2012 and March 2014 to determine the feasibility, test accuracy, and impact on @entity1906 disease management provided by the Xpert test in a remote, medically underserved, predominantly Inuit population in Iqaluit, Nunavut, Canada. Main Results: A total of 453 Xpert tests were run on sputum samples from 344 @entity1 with suspected @entity1906 . Twenty seven @entity1 were identified as having active @entity1906 disease by culture. There were no cases of drug resistant @entity1906 . Using culture as the gold standard, one Xpert test compared to 1,2 or 3 sputum samples cultured per @entity1 , had a sensitivity of 85% (66-95, CI 95%) and a specificity = 99% (97-100, CI 95%) for detection of MTB. The indeterminate rate was 4.4% of all samples run. Treatment initiation was significantly shortened using Xpert versus the national standard of three smears (1.8 vs 7.7 days, p <0.007), and particularly shorter in smear-negative, culture-positive cases (1.8 vs 37.1 days, p value< 0.008). Conclusions: In a predominantly Inuit population in a remote region of Canada where the burden of @entity1906 is high and no @entity1906 testing facilities are available, on-site Xpert was feasible, accurate and shortened time to @entity1906 treatment initiation.
