A Model of Tuberculosis Screening for Pregnant Women in Resource-Limited Settings Using Xpert MTB/RIF

Eleanor R Turnbull,German Henostroza,Stewart E Reid,Stephanie M Topp,Jennifer B Harris,Nzali G Kancheya

doi:10.1155/2012/565049

Abstract

Timely diagnosis and treatment of maternal tuberculosis (TB) is important to reduce morbidity and mortality for both the mother and child, particularly in women who are coinfected with HIV. The World Health Organization (WHO) recommends the integration of TB/HIV screening into antenatal services but available diagnostic tools are slow and insensitive, resulting in delays in treatment initiation. Recently the WHO endorsed Xpert MTB/RIF, a highly sensitive, real-time PCR assay for Mycobacterium tuberculosis that simultaneously detects rifampicin resistance directly from sputum and provides results within 100 minutes. We propose a model for same-day TB screening and diagnosis of all pregnant women at antenatal care using Xpert MTB/RIF. Pilot studies are urgently required to evaluate strategies for the integration of TB screening into antenatal clinics using new diagnostic technologies.

Highlights

Tuberculosis (TB) is a leading cause of nonobstetric maternal death in resource-limited settings, accounting globally for approximately 700,000 deaths every year, the majority of which are in areas with high HIV prevalence [1, 2]
The World Health Organization (WHO) endorsed Xpert MTB/RIF, a highly sensitive, real-time PCR assay for Mycobacterium tuberculosis that simultaneously detects rifampicin resistance directly from sputum and provides results within 100 minutes
We have highlighted the need for TB screening in pregnant women and proposed a model for a point of care screening algorithm with rapid turnaround time

Summary

Introduction

Tuberculosis (TB) is a leading cause of nonobstetric maternal death in resource-limited settings, accounting globally for approximately 700,000 deaths every year, the majority of which are in areas with high HIV prevalence [1, 2]. Rapid, early diagnosis and treatment of TB reduces transmission of TB to family members, including newborns, and the wider community [13] and reduces the number of women who are lost to followup during the lengthy TB diagnostic process. In light of these risks, it is clear that early, rapid diagnosis and treatment of both HIV and TB is critical to improve both maternal. The World Health Organization (WHO) recommends the integration of TB/HIV care into antenatal services and TB screening of all pregnant women in high HIV prevalence areas [15]

TB Diagnosis in Pregnant Women

TB Screening Model in Antenatal Clinics

Findings

Discussion