From Innovation to Impact: support for the roll-out of GeneXpert MTB/RIF
A new molecular assay called GeneXpert MTB/RIF (Xpert) to rapidly detect pulmonary tuberculosis (TB) and rifampicin resistance was endorsed by the World Health Organization (WHO) in 2010. Xpert is a rapid automated molecular diagnostic test that is more sensitive than direct sputum smear microscopy for TB and very accurate in detecting rifampicin resistance. The test is recommended by WHO as initial test for individuals with presumptive multidrug-resistant (MDR) TB, and also for individuals with presumptive TB who have HIV-infection or are seriously ill.
If properly applied, Xpert is expected to result in increased and earlier TB case detection, earlier initiation of treatment and eventually reduced morbidity, mortality and disease transmission.
One of the first global Xpert initiatives was the USAID-funded TB CARE I program. As lead agency of TB CARE I and its successor Challenge TB, KNCV Tuberculosis Foundation has been heavily involved in the implementation and scale-up of testing the Xpert diagnostic system. KNCV has directly supported the rollout of Xpert in at least ten countries. As a result, the number of patients diagnosed with rifampicin resistance (and confirmed as MDR-TB) has rapidly increased, saving lives and preventing transmission by adequate MDR-TB treatment.
In some cases countries are facing operational difficulties, and the performance of the diagnostic tool is not always optimal. Some examples of support to the roll-out of this innovation:
- Under the auspices of the National AIDS Control Agency (NACA) in Nigeria, KNCV is leading a team to build an Xpert network. The aim is to strengthen TB detection among people living with HIV. Read more: Control of TB among people with HIV/AIDS in Nigeria.
- KNCV has successfully run a pilot project for service provision of the GeneXpert machine in partnership with the company that manufactures the Xpert MTB/RIF platforms. Read more: Supporting the introduction of GeneXpert in Nigeria. KNCV continues to support the GeneXpert service provision in Nigeria and in Vietnam, and is working to establish similar projects in Tajikistan and Uzbekistan.
- Kazakhstan was one of the first countries to implement the new technologies for rapid diagnostic testing. KNCV supported the development of guidelines for the Programmatic Management of Drug-resistant TB (PMDT) and for the development of a national policy for ambulatory or outpatient care. During a patient-centered pilot project in the Akmola region, a system was developed for the reallocation of budget to ambulatory care. Another important new idea emerging from the Akmola project was the need for psychosocial support for patients, and for keeping track of patients and motivating them while they are on treatment at home. Read more: Dr. Malik Adenov Chief Doctor of the National TB Center, Kazakhstan: “We now know the direction we have to take.”
- In Botswana, KNCV has supported the national implementation of the GxAlert initiative: a system for data management. GxAlert is designed to work with any TB, HIV, Ebola, or malaria diagnostic device that is capable of connecting to the Internet. The system has the capacity to be integrated with devices from different companies. Read more: National Implementation of GxAlert in Botswana – integrated patient data management