Upfront Xpert MTB/RIF for diagnosis of pediatric TB—Does it work? Experience from India

Abstract

Background Diagnosis of TB in pediatric population poses several challenges. A novel initiative was implemented in several major cities of India aimed at providing upfront access to free-ofcost Xpert MTB/RIF to presumptive pediatric TB cases. This paper aims to describe the experience of implementing this large initiative and assess feasibility of the intervention in high TB burden settings. Methods Data were drawn from the pediatric TB project implemented in 10 major cities of India between April 2014 and March 2018. In each city, providers, both public and private, were engaged and linked with a high throughput Xpert MTB/RIF lab (established in that city) through rapid specimen transportation and electronic reporting system. Rates and proportions were estimated to describe the characteristics of this cohort. Results Of the total 94,415 presumptive pediatric TB cases tested in the project, 6,270 were diagnosed positive for MTB (6.6%) on Xpert MTB/RIF (vs 2% on smear microscopy). Among MTB positives, 545 cases were rifampicin resistant (8.7%). The median duration between

Treatment outcomes of children and adolescents receiving drug-resistant TB treatment in a routine TB programme, Mumbai, India

“…The low numbers of younger children in routine TB programme highlights the known challenges in childhood DR-TB diagnosis and linkage to treatment [ 3 ]. The national TB programmes must identify novel ideas for case finding and supporting the families during diagnosis and treatment of paediatric patients with DR-TB [ 24 ], one such being using GeneXpert as a primary tool for TB diagnosis in children [ 25 ].…”

Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries

“…To improve yield of bacteriologically confirmed TB in children, the NTEP now recommends use of molecular tests (such as Xpert MTB/RIF or Truenat TB test) in preference to smear examination in pulmonary, as well as extrapulmonary TB [27]. The sensitivity of molecular diagnostics varies from 15% to 30% in tertiary research settings, to less than 10% under programmatic conditions [32,33]. Of a total of 94,415 presumptive TB cases in Indian children presenting to public and private clinics in ten cities in India in which free-of-charge upfront Xpert MTB/RIF was used, Xpert was positive in 6.6% compared to 2% on smear microscopy for acid-fast bacilli (AFB) [33].…”

“…The sensitivity of molecular diagnostics varies from 15% to 30% in tertiary research settings, to less than 10% under programmatic conditions [32,33]. Of a total of 94,415 presumptive TB cases in Indian children presenting to public and private clinics in ten cities in India in which free-of-charge upfront Xpert MTB/RIF was used, Xpert was positive in 6.6% compared to 2% on smear microscopy for acid-fast bacilli (AFB) [33]. Around half of the specimens tested were non-sputum, and nearly 90% of positive cases commenced treatment on the day of diagnosis.…”

“…In the study of upfront Xpert MTB/RIF use, 545 (8.7%) of 6270 cases with Mycobacterium tuberculosis (M.tb.) complex detected by Xpert were rifampicin-resistant [33]. All diagnostic services are provided free through the NTEP laboratory network [30].…”

Implementation of a tuberculosis elimination project, India 2018–2019

“…Through the national programme’s strategic guidance, many private health-care providers were made aware of the necessity for and process of tuberculosis case notification. 11 – 15 Consequently, the private sector’s contribution to tuberculosis case notifications increased from less than 1% (3547/1 467 585) in 2012 to 21.0% (383 784/1 827 959) in 2017. 3 , 11 , 16 Despite this increase, about a million cases were not notified in 2017.…”