Xpert is more sensitive than sputum smear microscopy in detecting TB, and it has similar accuracy as culture. Moreover, its ability to detect smear-negative TB provides a significant advantage, especially for PLHIV. Importantly, its ability to detect RIF-resistant TB in less than 2 hours significantly improves the likelihood of timely treatment initiation. (Conventional culture and drug-susceptibility testing [DST] are still required to complete the drug-resistance profile and to monitor treatment.)
Xpert does cost more than smear microscopy; it requires a machine that currently costs US$17,000 and cartridges that cost US$9.98 for each test, in addition to human resource and other running costs. It also has operational limitations, such as the need for a sustained power supply. However, Xpert is intended to be used at facilities close to the patient to reduce the time to diagnosis and TB treatment initiation.