Abstract
As per national guidelines in Uzbekistan, all presumptive tuberculosis patients should be tested using the Xpert MTB/RIF assay for diagnosing tuberculosis. There is no published evidence how well this is being implemented. In this paper, we report on the Xpert coverage among presumptive tuberculosis patients in 2018 and 2019, factors associated with non-testing and delays involved. Analysis of national aggregate data indicated that Xpert testing increased from 24% in 2018 to 46% in 2019, with variation among the regions: 21% in Tashkent region to 100% in Karakalpakstan. In a cohort (January–March 2019) constituted of 40 randomly selected health facilities in Tashkent city and Bukhara region, there were 1940 patients of whom 832 (43%, 95% confidence interval (CI): 41–45%) were not Xpert-tested. Non-testing was significantly higher in Bukhara region (73%) compared to Tashkent city (28%). In multivariable analysis, patient’s age, distance between primary health centre (PHC) and Xpert laboratory, diagnostic capacity and site of PHC were associated with non-testing. The median (interquartile range) duration from date of initial visit to PHC to receiving results was 1 (1–2) day in Tashkent city compared to 3 (1–6) days in Bukhara region (p-value < 0.001). While there is commendable progress, universal access to Xpert testing is not a reality yet.
Highlights
An estimated 10 million people developed tuberculosis (TB) in 2019, of whom, only 7.1 million were reported by countries
Analysis of aggregate data indicated that Xpert MTB/RIF test coverage among presumptive TB patients increased from 24% in 2018 to 46% in 2019 (Table 2)
primary health centre (PHC) = primary health centers; GX = GeneXpert; interquartile ranges (IQR) = Interquartile range showing 25th and 75th centile; Max = maximum. This is the first study from Uzbekistan assessing the Xpert MTB/RIF test coverage among presumptive TB patients, factors associated with non-testing and time taken to obtain results
Summary
An estimated 10 million people developed tuberculosis (TB) in 2019, of whom, only 7.1 million were reported by countries. This leaves a gap of 29%, and such patients are referred to as the ‘missing millions’ [1]. (i) patients who did not access health care; (ii) patients who reached a health facility, but were not identified as having presumptive TB (previously known as TB suspects) by the health care providers; (iii) patients who were identified as ‘presumptive TB’, but were not investigated with the correct tests and diagnosed; (iv) patients who were diagnosed, but not started on treatment, and (v) patients who were treated (especially in the private health sector), but not reported to the national TB programmes (NTP) and the World Health.
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