Impact of Xpert MTB/RIF scale up in improving Rifampicin resistance TB detection - Experience from 5 regions in Tanzania

Abstract

Background: The WHO recommends the use of Xpert MTB/RIF technology rather than conventional microscopy, culture and DST as the initial diagnostic test for all presumptive TB cases. In 2017, there were an estimated 640 MDR/RR-TB cases, but only 200 cases of MDR-TB were identified in Tanzania, representing about 31% of the total estimated cases in the country. Tanzania has also revised the policy guideline to include Xpert MTB/RIF as primary diagnostic test among all presumptive TB cases although due to financial constraints the coverage of Xpert diagnostic facilities has remained low. USAID Boresha Afya Southern Zone program a comprehensive HIV Care project with support from USAID providing services in 5 regions has supported scale up of Gene X-pert machine in TB and RR-TB case detection. We document impact of Xpert scale up in improving RR-TB case detection. Methods and materials: The program mapped the number and location of Xpert machines available at all 35 district councils and only 11 councils had Xpert Machines. The program supported the efforts by the ministry to scale up Xpert machine availability by adding 27 new Xpert machines which increased a coverage to at least one Xpert machine per council. Furthermore, the program started supporting transport of sputum samples to X-pert sites by integrating sputum samples transportation with HIV Viral Load sample transportation system. Results: The number of RR-TB notifications increased by more than two folds from 21 cases in 2017 to 47 cases in 2018.Further more, the total number of TB cases notified increased from 8681 cases notified in 2017 to 9824 cases in 2018.Tabled 1PeriodJan-March 2017Apr-June 2017July-Sept 2017Oct -Dec 2017Jan-March 2018Apr-June 2018July-Sept 2018Oct- Dec 2018Number of RR-TB cases Detected44855101715 Open table in a new tab Conclusion: Use of Xpert MTB/RIF has demonstrated effectiveness in addressing the first pillar of the END TB Strategy; early diagnosis of TB including universal drug susceptibility testing. While there is a need to scale up Xpert machine to cover more sites, strengthening sputum sample transportation system to sites with Xpert machines will improve TB case detection in remote constrained settings.