{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:29:46Z","timestamp":1791257386687,"version":"4.1.0"},"reference-count":41,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,1,10]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The WHO endorsed the Xpert MTB\/RIF (Xpert) technique since 2011 as initial test to diagnose rifampicin-resistant tuberculosis (RR-TB). No systematic review has quantified the proportion of pretreatment attrition in RR-TB patients diagnosed with Xpert in high TB burden countries.<\/jats:p>\n                  <jats:p>Pretreatment attrition for RR-TB represents the gap between patients diagnosed and those who effectively started anti-TB treatment regardless of the reasons (which include pretreatment mortality (death of a diagnosed RR-TB patient before starting adequate treatment) and\/or pretreatment loss to follow-up (PTLFU) (drop-out of a diagnosed RR-TB patient before initiation of anti-TB treatment).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this systematic review and meta-analysis, we queried EMBASE, PubMed and Web of science to retrieve studies published between 2011 and 22 July 2024, that described pretreatment attrition for RR-TB using Xpert in high TB burden countries. Data on RR-TB patients who did not start treatment after diagnosis and reasons for not starting were extracted in an Excel table. A modified version of the Newcastle-Ottawa scale was used to evaluate the risk of bias among all included studies. The pooled proportion of pretreatment attrition and reasons were assessed using random-effects meta-analysis. Forest plots were generated using R software.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Thirty eligible studies from 21 countries were identified after full-text screening and included in the meta-analysis. Most studies used routine programme data. The pooled proportion of pretreatment attrition in included studies was 18% (95% CI: 12 to 25). PTLFU and pretreatment mortality were, respectively, reported in 10 and nine studies and explained 78% (95% CI: 51% to 92%) and 30% (95% CI: 15% to 52%) of attrition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Pretreatment attrition was widespread, with significant heterogeneity between included studies. National TB programmes should ensure accurate data collection and reporting of pretreatment attrition to enable reliable overall control strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42022321509.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-015977","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T01:35:15Z","timestamp":1737596115000},"page":"e015977","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Pretreatment attrition after rifampicin-resistant tuberculosis diagnosis with Xpert MTB\/RIF or ultra in high TB burden countries: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2591-8438","authenticated-orcid":false,"given":"Christelle Genevi\u00e8ve","family":"Jouego","sequence":"first","affiliation":[{"name":"Molecular Diagnostics Research Group (MDRG), University of Yaound\u00e9 1, Biotechnology Center, Nkolbisson, Cameroon"},{"name":"Unit of HIV and Tuberculosis, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1205-1484","authenticated-orcid":false,"given":"Tom","family":"Decroo","sequence":"additional","affiliation":[{"name":"Unit of HIV and Tuberculosis, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium"},{"name":"Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2341-6813","authenticated-orcid":false,"given":"Palmer Masumbe","family":"Netongo","sequence":"additional","affiliation":[{"name":"Molecular Diagnostics Research Group (MDRG), University of Yaound\u00e9 1, Biotechnology Center, Nkolbisson, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5518-9600","authenticated-orcid":false,"given":"Tinne","family":"Gils","sequence":"additional","affiliation":[{"name":"Unit of HIV and Tuberculosis, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium"},{"name":"University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"2025073013232590000_10.1.e015977.1","unstructured":"World Health Organization . Xpert MTB \/ RIF implementation manual technical and operational \u2018how-to\u2019: practical considerations. World Health Organization, 20 Avenue Appia, 1211Geneva 27, Switzerland: GPS publishing, 2014:1\u201352."},{"key":"2025073013232590000_10.1.e015977.2","article-title":"Xpert MTB\/RIF and Xpert MTB\/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults","volume":"6","author":"Horne","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2025073013232590000_10.1.e015977.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0077456","article-title":"Diagnostic accuracy and turnaround time of the Xpert MTB\/RIF assay in routine clinical practice","volume":"8","author":"Kwak","year":"2013","journal-title":"PLoS One"},{"key":"2025073013232590000_10.1.e015977.4","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.124800"},{"key":"2025073013232590000_10.1.e015977.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2025073013232590000_10.1.e015977.6","unstructured":"The World Health Organization . WHO global lists of high burden countries for tuberculosis (TB), TB\/HIV and TB (MDR \/ RR-TB). 2021\u20135."},{"key":"2025073013232590000_10.1.e015977.7","unstructured":"Wells GA , Shea B , O\u2019Connell D , et al . Newcastle - Ottawa quality assessment scale case control studies. Ottawa Hospital Research Institute, 1932:461\u201378."},{"key":"2025073013232590000_10.1.e015977.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025073013232590000_10.1.e015977.9","unstructured":"Deeks JJ , Higgins JPT , Altman DG , et al . Analysing data and undertaking meta-analyses. In: Higgins JPT , Thomas J , Chandler J , et al , eds. Cochrane handbook for systematic reviews of interventions version 64."},{"key":"2025073013232590000_10.1.e015977.10","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2019-300117"},{"key":"2025073013232590000_10.1.e015977.11","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1093\/trstmh\/trac054","article-title":"Pretreatment attrition and treatment initiation delay among rifampicin-resistant tuberculosis patients in Lagos, Nigeria: a retrospective cohort study","volume":"116","author":"Adejumo","year":"2022","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2025073013232590000_10.1.e015977.12","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.5588\/ijtld.17.0901","article-title":"Effects of Xpert MTB\/RIF testing and GxAlert on MDR-TB diagnosis and linkage to care in Mozambique","volume":"22","author":"Beste","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025073013232590000_10.1.e015977.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0129155","article-title":"The Multi-Drug Resistant Tuberculosis Diagnosis and Treatment Cascade in Bangladesh","volume":"10","author":"Hossain","year":"2015","journal-title":"PLoS One"},{"key":"2025073013232590000_10.1.e015977.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0236057","article-title":"Upfront Xpert MTB\/RIF for diagnosis of pediatric TB-Does it work? 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