Implementing rapid testing for tuberculosis in Mozambique

Cowan, James; Michel, Cathy; Manhiça, Ivan; Monivo, C.; Saize, D.; Creswell, Jacob; Gloyd, Stephen; Micek, Mark A.

doi:10.2471/blt.14.138560

Cited by 25 publications

(43 citation statements)

References 6 publications

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“…And even worse, 53% of those with Rifampicin resistance did not start treatment. 28 Raising the question whether it is ethical to expand only diagnostic services when the health system is not able to cope with the extra cases. 29 Nevertheless, for rural settings, with structural difficulties for standard GeneXpert installation, same-day sputum microscopy approach could be an alternative as it has demonstrated to have the same diagnostic accuracy as the traditional 2 days sampling and has also been endorsed by WHO.…”

Section: Discussionmentioning

confidence: 99%

Implementation challenges of a TB programme in rural northern mozambique: evaluation of 2012–2013 outcomes

Wikman-Jorgensen

Morales-Cartagena

Llenas-García

et al. 2015

Pathogens and Global Health

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Background: We aimed to identify challenges and to propose solutions for the implementation of tuberculosis (TB) programmes in rural Sub-Saharan Africa (SSA) by evaluating the outcomes of the TB programme in the Ancuabe district in rural Northern Mozambique. Methods: Retrospective descriptive study of the patients included in the TB programme in 2012-2013. Follow-up was continued till June 2014. Results: Three hundred nineteen patients were registered, 62.1% male, mean age 36.3 (SD 14.4), estimated case detection rate (eCDR) of 24.24%. Two hundred seventy-two were new cases, 21 transferred-in, 11 back after lost to follow-up (LTFU), 10 relapsing TB, 5 previous treatment failures. 94.4% were tested for Human immunodeficiency virus (HIV), 41.9% HIV-positive. 87.5% of the new cases were pulmonary TB (PTB), 43.4% were HIV co-infected. Initial sputum results were available in 207 cases, with 145 smear-positive (SP) cases. Outcomes of new cases: 122 (44.9%) LTFU, 55 (20.2%) cured, 43 (15.8%) treatment completed (98-36%-treatment success), 31 (11.4%) died, 19 (7%) transferred out and 2 (0.7%) failures. Conclusions: A low eCDR and high proportion of LTFU demonstrate that few patients were identified and had a low probability of complete treatment, suggesting a fragile health system. This raises the hypothesis that, probably, to improve TB health care in rural SSA, interventions should aim at improving health systems. Special attention should be given to social protection and compensation of the financial burden associated with TB.

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Section: Discussionmentioning

confidence: 99%

Implementation challenges of a TB programme in rural northern mozambique: evaluation of 2012–2013 outcomes

Wikman-Jorgensen

Morales-Cartagena

Llenas-García

et al. 2015

Pathogens and Global Health

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“…Unfortunately, most diagnostic tests are evaluated primarily in well-funded trials and demonstration studies, without good evidence of how they perform in the real world. For example, Xpert MTB/RIF was recommended on the basis of high-quality data about its accuracy and cost-effectiveness under controlled conditions and in a large field trial 26 ; however, emerging evidence has suggested that, in many settings, the characteristics of Xpert may be different when implemented in the field -including its sensitivity 69 , calibration 70 , positive predictive value (owing to low pre-test probability) 71 , and accuracy for rifampin resistance 72 . To make accurate assessments of the incremental value of diagnostics, we should collect such data early after launch, and update expectations and recommendations as those data become available.…”

Section: S65mentioning

confidence: 99%

Understanding the incremental value of novel diagnostic tests for tuberculosis

Arinaminpathy

Dowdy

2015

Nature

109

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Tuberculosis is a major source of global mortality caused by infection, partly because of a tremendous ongoing burden of undiagnosed disease. Improved diagnostic technology may play an increasingly crucial part in global efforts to end tuberculosis, but the ability of diagnostic tests to curb tuberculosis transmission is dependent on multiple factors, including the time taken by a patient to seek health care, the patient's symptoms, and the patterns of transmission before diagnosis. Novel diagnostic assays for tuberculosis have conventionally been evaluated on the basis of characteristics such as sensitivity and specificity, using assumptions that probably overestimate the impact of diagnostic tests on transmission. We argue for a shift in focus to the evaluation of such tests' incremental value, defining outcomes that reflect each test's purpose (for example, transmissions averted) and comparing systems with the test against those without, in terms of those outcomes. Incremental value can also be measured in units of outcome per incremental unit of resource (for example, money or human capacity). Using a novel, simplified model of tuberculosis transmission that addresses some of the limitations of earlier tuberculosis diagnostic models, we demonstrate that the incremental value of any novel test depends not just on its accuracy, but also on elements such as patient behaviour, tuberculosis natural history and health systems. By integrating these factors into a single unified framework, we advance an approach to the evaluation of new diagnostic tests for tuberculosis that considers the incremental value at the population level and demonstrates how additional data could inform more-effective implementation of tuberculosis diagnostic tests under various conditions

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“…Moreover, for TB diagnosis, the Xpert MTD/RIF assay is a fully automated nucleic acid ampli cation testing (NAAT) that can deliver a result in about 2 h, Which was widely thought to be e cient and cost-effective [13] . It has been endorsed by the World Health Organization and widely deployed [17]- [22] . Nevertheless, as yet, for most pathogens, especially the pathogens mainly caused cerebral parenchymal lesions, had low sensitivity and speci city means of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Etiological Detection for Cerebral Parenchymal Opportunistic Infections in AIDS Patients by PCR

Liang¹,

Yang²,

Liang³

et al. 2020

Preprint

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Background: Central nervous system (CNS) opportunistic infections (OIs) is one of the most important complication in Acquired Immune Deficiency Syndrome (AIDS) patients. As far as the cerebral parenchymal OIs (encephalitis) are concerned, the sensitivity and specificity of pathogens routine test methods are not highly acceptable at present.Objective: Detect the pathogens of cerebral parenchymal OIs in AIDS patients by polymerase chain reaction (PCR), to evaluate the utility of this method, and observe the etiology characteristics of cerebral parenchymal OIs and their impact on the prognosis in AIDS patients. Methods: We conducted a retrospective study design involving 33 formalin-fixed paraffin-embedded tissue (FFPET) samples of cerebral inflammatory lesions in AIDS patients from 2012 to 2020 were retrieved from the Department of Pathology, Beijing Ditan hospital affiliated to Capital Medical University. Pathogen-specific primers were used to detect DNA from cytomegalovirus (CMV), toxoplasma gondii (TG) and John Cunningham virus (JCV), via real-time PCR. Follow-up visits were conducted by telephone and outpatient service. Survival time after operation was counted.Results: Of 33 samples sent for PCR, 90.91% (30/33) were positive, 33 pathogens detected. JCV accounted for 60.61% (20/33) of all causes of cerebral parenchymal OIs, 21.21% (7/33) for CMV, 18.18% (6/33) for TG. IgG antibody against TG in serum (P=0.005) and in CSF (P=0.013) obviously correlated with TG expression in FFPET. The 0 pathogen patients tend to suffer from solitary lesion (P=0.018). JCV positive patients in FFPET tended to have higher odds of death (P=0.0096), whereas patients with TG positive showed lower odds of death (P=0.0431). Conclusion: JCV is the most prevalent pathogen of cerebral parenchymal OIs among AIDS patients, and tend to have a poor prognosis. The utility of the diagnostic method for pathogen identification by PCR combined with the investigation of etiological characteristics may improve the diagnosis and prognosis of AIDS related cerebral parenchymal OIs patients.

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Implementing rapid testing for tuberculosis in Mozambique

Cited by 25 publications

References 6 publications

Implementation challenges of a TB programme in rural northern mozambique: evaluation of 2012–2013 outcomes

Implementation challenges of a TB programme in rural northern mozambique: evaluation of 2012–2013 outcomes

Understanding the incremental value of novel diagnostic tests for tuberculosis

Etiological Detection for Cerebral Parenchymal Opportunistic Infections in AIDS Patients by PCR

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