Patient Experiences of Treatment Deferral for Evaluation and Monitoring after a Trace Xpert Ultra Result

BackgroundA "trace" result from the Xpert Ultra molecular TB test indicates Mycobacterium tuberculosis DNA detection but may not always signify TB disease. Little is known about the experiences of individuals with trace results who are not immediately treated. MethodsWe enrolled Ugandan adults and adolescents with trace Xpert Ultra sputum results, plus positive and negative controls, from community-screening and clinic settings. After a comprehensive TB evaluation, participants not recommended to start treatment immediately were closely monitored with interval reassessments. Surveys captured participants perceptions and preferences related to their uncertain TB status at baseline and during follow-up. ResultsA total of 321 people with trace sputum (PWTS), 236 positive controls, and 279 negative controls were enrolled. A minority of PWTS thought they were highly likely to have or develop TB, and most reported low associated anxiety initially (258/321, 80%) and during follow-up. While about half (172/321, 54%) would have favored treatment at baseline if not in the study, those who remained untreated were less inclined toward treatment at six months. Participants generally preferred sensitive diagnostic tests, even with frequent false positives. ConclusionsDeferring treatment for PWTS, with sufficient testing and monitoring, is acceptable to most patients.