Monitoring quality indicators for the Xpert MTB/RIF molecular assay in Ethiopia

Kebede, Abebaw; Beyene, Dereje; Yenew, Bazezew; Diriba, Getu; Mehamd, Zemedu; Alemu, Ayinalem; Amare, Misikr; Ameni, Gobena

doi:10.1371/journal.pone.0225205

Cited by 17 publications

(13 citation statements)

References 26 publications

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“…First, the maintenance cost for the diagnostic machines was not included in this analysis. Excluding the cost of maintenance might significantly affect the total unit cost of the diagnostic methods [ 35 , 36 ]. Furthermore, although the information on the diagnosis accuracy of the techniques in TB-HIV co-infection cases would be relevant, because of the data limitation, TB-HIV co-infection was not included.…”

Section: Discussionmentioning

confidence: 99%

Costs and cost-effectiveness of Gene Xpert compared to smear microscopy for the diagnosis of pulmonary tuberculosis using real-world data from Arsi zone, Ethiopia

Kaso

Hailu

2021

PLoS ONE

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Background Early diagnosis and treatment are one of the key strategies of tuberculosis control globally, and there are strong efforts in detecting and treating tuberculosis cases in Ethiopia. Smear microscopy examination has been a routine diagnostic test for pulmonary tuberculosis diagnosis in resource-constrained settings for decades. Recently, many countries, including Ethiopia, are scaling up the use of Gene Xpert without the evaluation of the cost and cost-effectiveness implications of this strategy. Therefore, this study evaluated the cost and cost-effectiveness of Gene Xpert (MTB/RIF) and smear microscopy tests to diagnosis tuberculosis patients in Ethiopia. Methods We compared the costs and cost-effectiveness of tuberculosis diagnosis using smear microscopy and Gene Xpert among 1332 patients per intervention in the Arsi zone. We applied combinations of top-down and bottom-up costing approaches. The costs were estimated from the health providers’ perspective within one year (2017–2018). We employed “cases detected” as an effectiveness measure, and the incremental cost-effectiveness ratio was calculated by dividing the changes in cost and change in effectiveness. All costs and incremental cost-effectiveness ratio were reported in 2018 US$. Results The unit cost per test for Gene Xpert was $12.9 whereas it is $3.1 for AFB smear microscopy testing. The cost per TB case detected was $77.9 for Gene Xpert while it was $55.8 for the smear microscopy method. The cartridge kit cost accounted for 42% of the overall Gene Xpert’s costs and the cost of the reagents and consumables accounted for 41.3% ($1.3) of the unit cost for the smear microscopy method. The ICER for the Gene Xpert strategy was $20.0 per tuberculosis case detected. Conclusion Using Gene Xpert as a routine test instead of standard care (smear microscopy) can be potentially cost-effective. In the cost scenario analysis, the price of the cartridge, the number of tests performed per day, and the life span of the capital equipment were the drivers of the unit cost of the Gene Xpert method. Therefore, Gene Xpert can be a part of the routine TB diagnostic testing strategy in Ethiopia.

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Section: Discussionmentioning

confidence: 99%

Costs and cost-effectiveness of Gene Xpert compared to smear microscopy for the diagnosis of pulmonary tuberculosis using real-world data from Arsi zone, Ethiopia

Kaso

Hailu

2021

PLoS ONE

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“…Molecular methods, such as polymerase chain reaction (PCR), combine high sensitivity with high specificity. Even in resource-constrained settings, user-friendly PCR platforms are nowadays well-established for routine diagnosis and surveillance of tuberculosis [ 11 ] and HIV [ 12 ]. Although such molecular tools have the potential to be used for other neglected diseases like leishmaniasis as well [ 13 , 14 ], there is still a long way to go before implementation in routine care.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of conventional and four real-time PCR methods for the detection of Leishmania on field-collected samples in Ethiopia

et al. 2021

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In most low-resource settings, microscopy still is the standard method for diagnosis of cutaneous leishmaniasis, despite its limited sensitivity. In Ethiopia, the more sensitive molecular methods are not yet routinely used. This study compared five PCR methods with microscopy on two sample types collected from patients with a suspected lesion to advise on optimal diagnosis of Leishmania aethiopica. Between May and July 2018, skin scrapings (SS) and blood exudate from the lesion spotted on filter paper (dry blood spot, DBS) were collected for PCR from 111 patients of four zones in Southern Ethiopia. DNA and RNA were simultaneously extracted from both sample types. DNA was evaluated by a conventional PCR targeting ITS-1 and three probe-based real-time PCRs: one targeting the SSU 18S rRNA and two targeting the kDNA minicircle sequence (the ‘Mary kDNA PCR’ and a newly designed ‘LC kDNA PCR’ for improved L. aethiopica detection). RNAs were tested with a SYBR Green-based RT-PCR targeting spliced leader (SL) RNA. Giemsa-stained SS smears were examined by microscopy. Of the 111 SS, 100 were positive with at least two methods. Sensitivity of microscopy, ITS PCR, SSU PCR, Mary kDNA PCR, LC kDNA PCR and SL RNA PCR were respectively 52%, 22%, 64%, 99%, 100% and 94%. Microscopy-based parasite load correlated well with real-time PCR Ct-values. Despite suboptimal sample storage for RNA detection, the SL RNA PCR resulted in congruent results with low Ct-values. DBS collected from the same lesion showed lower PCR positivity rates compared to SS. The kDNA PCRs showed excellent performance for diagnosis of L. aethiopica on SS. Lower-cost SL RNA detection can be a complementary high-throughput tool. DBS can be used for PCR in case microscopy is negative, the SS sample can be sent to the referral health facility where kDNA PCR method is available.

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“…Other data collection tools included the 10-item Cohen Perceived Stress Scale [ 10 , 26 , 27 , 29 ], 14-item Shirom-Melamed Burnout measure [ 10 ], 7-item Insomnia Severity Index [ 12 , 26 , 28 , 30 ], 22-item Impact of Event Scale-Revised [ 12 , 28 ], 16-item Stanford Professional Fulfilment Index [ 12 , 28 ], Hospital Anxiety Depression Score [ 13 ], Coronavirus Anxiety Scale [ 17 ] and Primary Care PTSD Screen. [ 15 ] The differences in prevalence of anxiety and depression across studies even when using the same tools may be explained by different cutpoints, study populations (primarily doctors versus primarily nurses), settings (COVID-19 specialist services versus general medicine, obstetrics [ 31 ] and psychiatry [ 14 ]), health system capacity, data collection methods (online versus in-person interviewer or self-administered) and timing of the survey in relation to the global and national pandemic situation. Of note, while most studies used standardised data collection tools they were not necessarily validated for the context or the population.…”

Section: Discussionmentioning

confidence: 99%

Psychological distress among healthcare workers accessing occupational health services during the COVID-19 pandemic in Zimbabwe

Chingono

Nzvere

Marambire

et al. 2022

Comprehensive Psychiatry

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Monitoring quality indicators for the Xpert MTB/RIF molecular assay in Ethiopia

Cited by 17 publications

References 26 publications

Costs and cost-effectiveness of Gene Xpert compared to smear microscopy for the diagnosis of pulmonary tuberculosis using real-world data from Arsi zone, Ethiopia

Costs and cost-effectiveness of Gene Xpert compared to smear microscopy for the diagnosis of pulmonary tuberculosis using real-world data from Arsi zone, Ethiopia

Evaluation of conventional and four real-time PCR methods for the detection of Leishmania on field-collected samples in Ethiopia

Psychological distress among healthcare workers accessing occupational health services during the COVID-19 pandemic in Zimbabwe

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