The impact of the roll-out of rapid molecular diagnostic testing for tuberculosis on empirical treatment in Cape Town, South Africa
The GeneXpert is a molecular test for tuberculosis (TB) which is much more sensitive than the mainstay of diagnosis in most parts of the world, sputum smear microscopy. South Africa was one of the first countries to implement it as the first-line diagnostic for TB. This study shows the impact of this new test on the diagnosis of TB in Cape Town over a five year period. Treatment without a confirmed diagnosis (empirical treatment) reduced, but this reduction slowed down over time as clinicians got used to the new test. Nevertheless, still over a quarter of HIV-positive patients were treated without confirmation, highlighting the remaining difficulties in diagnosing TB in high TB and HIV burden settings.