Implementation of Xpert MTB/RIF in 22 high tuberculosis burden countries: are we making progress?

Cazabon, Danielle; Oghor, Collins; Qin, Zhi Zhen; Kik, Sandra V.; Denkinger, Claudia M.; Pai, Madhukar

doi:10.1183/13993003.00918-2017

Cited by 38 publications

(38 citation statements)

References 7 publications

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“…A structured questionnaire ( Supplementary File 1) was created based on two previous studies 3 4 , and sent via e-mail to staff members of Ministries of Health, National TB Programs (NTP), National Reference Laboratories and TB research institutes of 22 HBCs, as defined by WHO prior to 2015 5 . A maximum of two staff members were contacted per HBC.…”

Section: Methodsmentioning

confidence: 99%

“…While the roll out of these diagnostic tools is promising, previous analyses from Qin et al in 2014 and Cazabon et al in 2015 showed low market penetration in comparison to the conventional sputum smear microscopy test - there were 32.6 and 9.1 sputum smears for every Xpert MTB/RIF test procured in 2014 and 2015, respectively 3 4 . To assess 3-year trends in the public sector, we assessed the smear and Xpert MTB/RIF volumes for the year 2016 and studied changes in Xpert MTB/RIF market penetration and policies from 2014–2016 within 22 HBCs.…”

Section: Introductionmentioning

confidence: 99%

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Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016

et al. 2018

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Background: Xpert® MTB/RIF, a rapid tuberculosis (TB) molecular test, was endorsed by the World Health Organization in 2010. Since then, 34.4 million cartridges have been procured under concessional pricing. Although the roll out of this diagnostic is promising, previous studies showed low market penetration. Methods: To assess 3-year trends of market penetration of Xpert MTB/RIF in the public sector, smear and Xpert MTB/RIF volumes for the year 2016 were assessed and policies from 2014-2016 within 22 high-burden countries (HBCs) were studied. A structured questionnaire was sent to representatives of 22 HBCs. The questionnaires assessed the total smear and Xpert MTB/RIF volumes, number of modules and days of operation of GeneXpert machines in National TB Programs (NTPs). Data regarding the use of NTP GeneXpert machines for other diseases and GeneXpert procurement by other disease control programs were collected. Market penetration was estimated by the ratio of total sputum smear volume for initial diagnosis divided by the number of Xpert MTB/RIF tests procured in the public sector. Results: The survey response rate was 21/22 (95%). Smear/Xpert ratios decreased in 17/21 countries and increased in four countries, since 2014. The median ratio decreased from 32.6 (Q1:14.3, Q3: 58.9) in 2014 to 6.0 (Q1: 1.6, Q3: 17.0) in 2016. Nineteen countries (19/19; 100%) were not using GeneXpert machines to their full capacity, however seven countries (7/19; 37%) were running tests for other diseases on their NTP-procured GeneXpert systems in 2017, such as HIV, hepatitis-C virus (HCV), Chlamydia trachomatis, and Neisseria gonorrhoeae. Five (5/15; 33%) countries reported GeneXpert procurement by HIV or HCV programs in 2016 and/or 2017. Conclusions: Our results show a positive trend for Xpert MTB/RIF market penetration in 21 HBC public sectors. However, GeneXpert machines were under-utilized for TB, and inadequately exploited as a multi disease technology.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016

et al. 2018

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“…Over 23 million Xpert cartridges had been procured under concessional pricing globally, and more and more countries are starting to replace smears with Xpert. 6 So, I see no reason to wind the clock back, and scale back our ambition, to a test that has modest accuracy, cannot detect drug resistance, and will be challenging to scale-up.…”

Section: Do Rats Pass the Sniff Test?mentioning

confidence: 99%

Do rats pass the sniff test?

Pai

2017

int j tuberc lung dis

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“…As a result of these rapid change, countries have experienced different level of progress in adopting and fully implementing TB laboratory policies and strategies [11]. In this context, among its several mandates, the WHO play a crucial role in directing and coordinating the international public health efforts through assistance to countries, partnerships, and initiatives with the aim to facilitate translation of policy into practice.…”

Section: Introductionmentioning

confidence: 99%

Is deployement of diagnostic test alone enough? Comprehensive package of interventions to strengthen TB laboratory network: three years of experience in Burkina Faso

Alagna

Combary²,

Tagliani

et al. 2020

Preprint

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Backgrounds Laboratory plays a critical role in tuberculosis (TB) control by providing testing for diagnosis, treatment monitoring, and surveillance at each level of the health care system. Weak accessibility to TB diagnosis services still represents a big concern in many limited resources’ countries. Here we review the experience of Burkina Faso in implementing a comprehensive intervention packages to strengthen TB laboratory capacity and diagnostic accessibility. Methods Interventions lasted from October 2016 to December 2018 and focused on two main areas: i) development of strategic documents and policies; ii) implementation of TB diagnostic technology. National TB laboratory data were collected over 2016–2018, stratified according to five programmatic TB laboratory indicators: i) Percentage of notified new and relapse TB cases with bacteriological confirmation; ii) Percentage of notified new and relapse TB cases tested with a WHO-recommended rapid diagnostic test (WRD); iii) Percentage of notified, bacteriologically confirmed TB cases with DST results for rifampin; iv) Percentage of notified MDR-TB cases; v) Smear/Xpert ratio. We evaluated the following indicators between 2016-2017 and 2016-2018 Results From 2016 to 2018 the number of bacteriologically confirmed cases increased of 4%. The number of new and relapse TB cases notified tested with a WRD increase of 27% compared to 2016 and the number of bacteriologically confirmed cases with an available DST result for rifampicin increased from 27% of 2016 to 66% in 2018. The number of MDR-TB cases notified over the number of estimated MDR-TB cases in 2018 increase of 35% compared to 2016. In 2018, the ratio between the number of smear microscopy and Xpert MTB/RIF test decreased from 53 in 2016 to 21 to 2018. Conclusion We demonstrated that implementation of comprehensive package of laboratory strengthening interventions had a positive effect on the evaluated indicators and external assistance has played a fundamental role in speeding up the TB laboratory system improvement process

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Implementation of Xpert MTB/RIF in 22 high tuberculosis burden countries: are we making progress?

Cited by 38 publications

References 7 publications

Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016

Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016

Do rats pass the sniff test?

Is deployement of diagnostic test alone enough? Comprehensive package of interventions to strengthen TB laboratory network: three years of experience in Burkina Faso

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