Table 2– World Health Organization (WHO) policy recommendations on Xpert MTB/RIF
The GRADE process confirmed a solid evidence base to support widespread use of Xpert MTB/RIF for detection of TB and rifampicin resistance and resulted in the following main recommendations:
 Xpert MTB/RIF should be used as the initial diagnostic test in individuals suspected of having MDR-TB or HIV-associated TB (strong recommendation)
 Xpert MTB/RIF may be considered as a follow-on test to microscopy in settings where MDR-TB or HIV is of lesser concern, especially in further testing of smear-negative specimens (conditional recommendation, acknowledging major resource implications)
 These recommendations apply to the use of Xpert MTB/RIF in sputum specimens (including pellets from decontaminated specimens)
 Data on the utility of Xpert MTB/RIF in extrapulmonary specimens are still limited
 These recommendations support the use of one sputum specimen for diagnostic testing, acknowledging that multiple specimens increase the sensitivity of Xpert MTB/RIF but have major resource implications
 These recommendations also apply to children, based on the generalisation of data from adults and acknowledging the limitations of microbiological diagnosis of TB (including MDR-TB) in children
 Access to conventional microscopy, culture and DST is still needed for monitoring of therapy, prevalence surveys and/or surveillance and recovering isolates for DST other than rifampicin (including second-line anti-TB drugs)
  • GRADE: Grades of Recommendations Assessment, Development and Evaluation; MDR: multidrug resistant; DST: drug susceptibility testing. Data from [6].