Implementation of Xpert MTB/RIF for routine point-of-care diagnosis of tuberculosis at the primary care level

as a first-line diagnostic for TB in patients suspected of HIV-associated TB or multidrug-resistant (MDR) TB.1 South Africa, the first country to roll out the assay, opted to place the instruments at centralised microscopy centres and reference laboratories of the National Health Laboratory Service, mainly owing to cost considerations and to allow rapid roll-out.2 Xpert MTB/RIF (Xpert)’s short turnaround time and simplicity raised potential for point-of-care (POC) use.3,4 The motivation for POC technology (be it HIV, CD4 or TB testing) is to provide same-day results, hasten treatment initiation, and avoid loss to follow-up during the diagnostic process. Little is known about POC use of Xpert at primary healthcare level, and operational research is needed before its use at the peripheral level can be recommended.3,5 In July 2011, we launched Xpert as the initial, routine, POC diagnostic for all TB suspects at Witkoppen Health and Welfar