Has the utilisation of Xpert^® MTB/RIF in Manicaland Province, Zimbabwe, improved with new guidance on whom to test?

Abstract

Z imbabwe has one of the world's highest tuberculosis (TB) burdens, with an estimated TB incidence of 208 cases per 100 000 population and an associated TB-HIV (human immunodeficiency virus) coinfection rate of 67% in 2016. 1 For many years, the diagnosis of pulmonary TB has relied on sputum smear microscopy, although the test has poor sensitivity and does not detect drug-resistant TB. 2 The introduction of the Xpert ® MTB/RIF assay (Cepheid Inc, Sunnyvale, CA, USA) is a game changer in this regard: Xpert is a fully automated, commercially available nucleic-acid amplification test for sputum and other specimens requiring minimal laboratory expertise, with results available within 2 h. 3 Sensitivity and specificity for the diagnosis of Mycobacterium tuberculosis are high, and the assay also detects rifampicin (RMP) resistant TB (RR-TB). Early studies showed that the diagnosis of TB using Xpert was feasible and accurate, 4 prompting the World Health Organization (WHO) in 2010 to strongly rec

Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China

“…Our study found a significant increase (11%) in bacteriological confirmation when Xpert was offered to all presumptive patients. This was similar to studies in other countries and regions [12,[27][28][29], although the proportion varied, ranging from 5% in Zimbabwe [29] to 59% in Brazil [27]. We also noted the relatively low sensitivity of Xpert in this study (88% for smear-positive, culture-positive patients; 64% for smear-negative, culture-positive patients) compared to the findings in a Cochrane review (98% for smearpositive, culture-positive patients; 67% for smear-negative, culture-positive patients) [30].…”

Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes

“…Inadequate coverage of diagnostic and treatment facilities, as well as the poor availability of health products and other operational challenges is well documented in studies from SSA [ 56 – 58 , 62 , 65 – 68 , 70 – 79 ]. Our study agrees with these findings.…”

Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review

“…47 ► Enable same day treatment initiation after Xpert 37 ► Two sputum specimen at baseline 27 ► Increase capacity and quality of inpatient and community-based care 51 ► Ensuring continuous supply of health products. 49 ► Expanded and timely access to treatment regimens, facilities and strategies. 8 21 23 Affordability:…”