GeneXpert Machines Research Articles

Accessibility of Finding Tuberculosis Case Actively, Separate Safely and Treat Effectively (FAST) Strategy for Early Detection of Suspected and Symptomatic Tuberculosis Patients: A Hospital Based Quantitative Study

Introduction: Tuberculosis is a contagious disease which has always been a challenge over the course of human history. It is known to spread mostly from persons with undiagnosed and suspected tuberculosis cases. Diagnosing tuberculosis in an early stage with effective treatment is one of the best ways to reduce the burden of tuberculosis. Finding cases Actively, Separate safely and Treat effectively (FAST) Strategy in Nepal, is a rapid diagnostic tool for rapid tuberculosis case detection. Aims: To access tuberculosis case Actively, Separate safely and Treat effectively (FAST) strategy for suspected and symptomatic tuberculosis patients coming to the hospital for early case detection and also to identify patient’s health care behaviour, technical barrier during surveillance. Methods: An observational quantitative study of active cough surveillance was carried at an entry point of FAST corner of Nepalgunj Medical College Teaching Hospital, Banke from April 2023 to December 2023. Scrutinized data was obtained by purposive sampling method with sample size 128 from FAST corner. Results: Maximum cases belonged to the aged group 65 and above having lower middle to lower socioeconomic status. Most of them were from joint family with contact history of tuberculosis in 35 (27.3) % of total cases. Out of total cases, 72 (56.25) % were confirmed with tuberculosis. Among those confirmed tuberculosis cases, multi drug resistance TB was found in 6 (4.7) %. Uses of mask was found significant (P< 0.05) in our study although number of these health care behaviour were less appropriate. Pneumonia was a significant association 17 (P = 0.004) with tuberculosis patient. Insufficient volunteers, and limited Gene xpert machine were major barriers to implement FAST strategy screening in Hospital. Conclusion: FAST strategy is feasible tool in high tuberculosis burden healthcare settings in Nepal. However, the technical and behavioral factors should be managed to ensure an effective approach.

A tuberculosis elimination-focused geospatial approach to optimising access to diagnostic GeneXpert machines in Fiji.

Fiji could be the first country to eliminate tuberculosis. To inform this strategy, we aimed to identify how many GeneXpert® machines are required to enable over 90% of Fijians to be within one-hour easy access. We used Geographic Information System (Quantum GIS; QGIS), OpenStreetMap and population data (Kontur) to map possible facilities in relation to QGIS generated 60-min drive-time isochrones, with correction for missing road data. For outer islands, we calculated a distance to nearest hub operation. The solution comprised 24 GeneXpert® machines, allocating 7 GeneXpert® to Viti Levu, 6 GeneXpert® to Vanua Levu and 11 to other islands. This resulted in 827,810 people, 93.6% of Fiji's population, being within 1 h of a machine. Twenty-one thousand four hundred seventy-nine people on outer islands were an average of 43 km by water from the nearest facility. We conclude that over 90% of Fijians could be within an hour of a GeneXpert® machine with placement of 24 machines.

Evaluation of a population-wide, systematic screening initiative for tuberculosis on Daru island, Western Province, Papua New Guinea

BackgroundA population-wide, systematic screening initiative for tuberculosis (TB) was implemented on Daru island in the Western Province of Papua New Guinea, where TB is known to be highly prevalent. The initiative used a mobile van equipped with a digital X-ray device, computer-aided detection (CAD) software to identify TB-related abnormalities on chest radiographs, and GeneXpert machines for follow-on diagnostic testing. We describe the results of the TB screening initiative, evaluate its population-level impact and examine risk factors associated with TB detection.MethodsThrough a retrospective review of screening data, we assessed the effectiveness of the screening by examining the enrolment coverage and the proportion of people with TB among screened subjects. A cascade analysis was performed to illustrate the flow of participants in the screening algorithm. We conducted univariate and multivariate analyses to identify factors associated with TB. Furthermore, we estimated the number of additional cases detected by the project by examining the trend of routine TB case notifications during the intervention period, compared to the historical baseline cases and trend-adjusted expected cases.ResultsOf the island’s 18,854 residents, 8,085 (42.9%) were enrolled and 7,970 (98.6%) had chest X-ray interpreted by the CAD4TB software. A total of 1,116 (14.0%) participants were considered to have abnormal CXR. A total of 69 Xpert-positive cases were diagnosed, resulting in a detection rate of 853 per 100 000 population screened. 19.4% of people with TB had resistance to rifampicin. People who were in older age groups (aOR 6.6, 95%CI: 1.5–29.1 for the 45–59 age group), were severely underweight (aOR 2.5, 95%CI:1.0-6.1) or underweight (aOR 2.1, 95%CI: 1.1–3.8), lived in households < 5 people (aOR 3.4, 95%CI:1.8–6.6) and had a past history of TB (aOR 2.1, 95%CI: 1.2–3.6) were more likely to have TB. The number of bacteriologically confirmed TB notified during the intervention period was 79.3% and 90.8% higher than baseline notifications and forecasted notifications, respectively.ConclusionThe screening project demonstrated its effectiveness with the high Xpert-positive TB prevalence among the participants and by successfully yielding additional cases of bacteriologically confirmed TB including rifampicin-resistant TB. The results and lessons learnt from the project should inform future TB screening initiatives in Papua New Guinea.

Pattern of Changes in Some Biochemical Indicators and Prevalence of HIV Seropositive People Co-Infected with Tuberculosis at FMC, Owerri, Imo State

The purpose of this study was to count the number of human immunodeficiency virus (HIV) patients receiving antiretroviral therapy (ART) who were also infected with tuberculosis (TB) and to evaluate the patients’ changes in certain biochemical parameters at the Federal Medical Centre in Owerri, Imo State. For this study, 350 HIV-positive patients between the ages of 20 and 79 years old who gave their consent were enrolled. National serial algorithms (Determine, Unigold, and StatPak) were utilized for HIV testing, whereas the GeneXpert machine was used for TB testing. While 4 ml of blood was collected in simple vials and the serum used for biochemical analysis, the biochemical analyses were performed using autoanalyzers. The risk of having both TB and HIV was highest in people aged 70 to 79 (31.11%) and lowest in people aged 50 to 59 (10.0%). According to sex, ladies (15.7%) had a greater prevalence of co-infection than males (14.3%). Between ART and non-ART individuals in this study, the results of the biochemical examinations showed that the ART group’s (test subjects’) kidney indicators, urea, and creatinine, as well as their liver enzymes (AST, ALT, and ALP), were statistically higher (P &lt; 0.05) than those of non-ART patients (control group). TB co-infection is more likely to affect elderly HIV-positive individuals due to their weakened immune systems by nature. Additionally, people with HIV who are not on ART run the risk of developing opportunistic infections as well as anemia. In addition to the administration of highly active antiretroviral therapy (HAART), they should be managed with additional caution. Antiretroviral medications have the potential to negatively impact vital organs like the kidneys and liver, necessitating therapeutic drug monitoring. To ensure patient compliance, more measures need to be taken by those in charge of managing these patients.

Prevalence of genital high-risk human papillomavirus infections and associated factors among women living with human immunodeficiency virus in Uganda

BackgroundWomen living with HIV are at risk for cervical dysplasia and cancer worldwide. In 2015, the World Health Organization (WHO) recommended that testing for high-risk HPV (hrHPV) infection be incorporated into cervical cancer screening programs using molecular nucleic acid tests (NATs) but this has not previously been done in Uganda. The country’s coverage for Human Papilloma Virus (HPV) screening remains low at less than 10% for women aged 25–49 years. This study determined the genital prevalence of hrHPV infection and the associated factors among women living with HIV in Uganda.MethodsA descriptive cross-sectional study was conducted in 15 selected health facilities among participants who were on Antiretroviral therapy (ART). Participants who consented to participate were instructed on how to collect their own high vaginal swabs using a cervical brush for HPV molecular testing (HPV DNA or HPV RNA) and their demographics data was collected using a standard questionnaire. Laboratory diagnosis for HPV molecular testing was done using Gene xpert machines and Hologic Aptima Machine. Modified Poisson regression analysis was conducted to determine the associated factors.ResultsThis study involved 5856 HIV positive participants on ART. A total of 2006 out of 5856 (34.3%) participants had high risk HPV infections. HPV infections by genotypes were: HPV16 317(15.8%), HPV 18/45 308 (15.4%) and other high-risk HPV 1381 (68.8%). The independent factors associated with all hrHPV were parity, education level, having more than one partner, and engaging in early sex. Smoking was associated with HPV 16, HPV 18/45 and other hrHPV. Age was associated with all hrHPV, marital status with HPV 16, and occupation with HPV 16.ConclusionsThe prevalence of genital high-risk HPV infections among HIV positive women attending ART clinics in public facilities in Uganda was high. Other hrHPV genotype was the commonest compared to 18/45 and HPV 16. The integration of cervical cancer screening in ART programmes remains paramount to support the early detection of cervical cancer and Non-invasive self-collected urine and vaginal sampling for cervical cancer screening present an opportunity.

Detection of mycobacterium tuberculosis by microscopic examination and gene expert in a suspected patient with pulmonary tuberculosis disease, in Dili City, East Timor

Tuberculosis is one of the most dangerous and deadly diseases, so control is needed to reduce the transmission rate of TB disease and mortality among the community, so the gene method is very appropriate to be able to help in diagnosing TB. Acid-resistant bacilli are bacteria that have a very thick lipid content so that the staining cannot be affected by other dye reactions, except by using phenol and through the heating process. Mycobacterium tuberculosis has a cell wall consisting of a waxy coating and mycolic acid; therefore, these bacteria can only color with BTA. Mycbakterium Tuberculosis can maintain the first color, namely Carbun Fuchin, and fight decolorization with alcoholic acid, so this bacterium is called an acid-resistant bacillus. The right examination method to diagnose TB disease is necessary to be able to follow the appropriate treatment so as to reduce transmission and death rates due to TB disease. The aim of this research is to analyze the difference in examination results using microscopes and Gene Xpert machines in Dili district in suspected patients with pulmonary tuberculosis.

Prevalence of Mycobacterium tuberculosis among HIV Patients Attending Federal Medical Centre Asaba, Delta State, Nigeria

Aim: The study aimed to ascertain the prevalence of tuberculosis among HIV-positive patients at the Federal Medical Center Asaba in Delta State, Nigeria.&#x0D; Study Design: This study engaged a cross-sectional study design to prevalence of Mycobacterium Tuberculosis among HIV Patients Attending Federal Medical Centre Asaba, Delta State.&#x0D; Place and Duration of the Study: The study was conducted in Federal Medical Center. Data collection spanned a specific duration from November, 2022 to January, 2023.&#x0D; Methodology: A total of 188 samples were obtained from known HIV patients. The patients were selected by random sampling technique. The samples were analysed using GeneXpert machine (GX2.1 model) with the nuclei acid amplification (NAA) of DNA mycobacterium tuberculosis complex (MTBC) and resistance to rifampicin. Demographic data of participants were obtained through questionnaires.&#x0D; Results: Out of 188 samples from HIV patients analyzed, MTB was detected in 13 (8.7%) patients with the highest prevalence recorded among male subjects 6(12%). Age group 19-29 was the most prevalent of MTB among the test subjects.&#x0D; Conclusion: Mycobacterium tuberculosis is widespread among HIV patients in Asaba, Delta state, according to these data. As a result, patients must be encouraged to adhere to treatment and preventive measures.

Impact of the COVID-19 pandemic on tuberculosis control in Indonesia: a nationwide longitudinal analysis of programme data

The impact of the COVID-19 pandemic on tuberculosis control in high-burden countries has not been adequately assessed. We aimed to estimate the impact of the COVID-19 pandemic on the national tuberculosis programme in Indonesia, in association with indicators of human development and health-system capacity across all 514 districts in 34 provinces. We did a nationwide longitudinal analysis to compare tuberculosis case notification, treatment coverage, and mortality rates in Indonesia before (2016-19) and during (2020-21) the COVID-19 pandemic. The following outcomes were assessed: the district-level quarterly reported tuberculosis case notification rate (number of all reported tuberculosis cases per 100 000 population), treatment coverage (proportion of tuberculosis patients who started treatment), and all-cause mortality rate in patients with tuberculosis (number of reported deaths per 100 000 population). District-level data on COVID-19 incidence and deaths, health-system capacity, and human development and sociodemographics were also analysed. Multilevel linear spline regression was done to assess quarterly time trends for the three outcomes. During the COVID-19 pandemic, the tuberculosis case notification rate declined by 26% (case notification rate ratio 0·74, 95% CI 0·72-0·77) and treatment coverage declined by 11% (treatment coverage ratio 0·89, 95% CI 0·88-0·90), but there was no significant increase in all-cause mortality (all-cause mortality rate ratio 0·97, 95% CI 0·91-1·04) compared with the pre-pandemic period. In the second year of the pandemic, we observed a partial recovery of the case notification rate from Q1 to Q4 of 2021, a persistent decrease in treatment coverage, and a decrease in the all-cause mortality rate from Q2 of 2020 to Q4 of 2021. The multivariable analysis showed that the reduction in the tuberculosis case notification rate was associated with a higher COVID-19 incidence rate (adjusted odds ratio 3·1, 95% CI 1·1-8·6, for the highest compared with the lowest group) and fewer GeneXpert machines for tuberculosis diagnosis (3·1, 1·0-9·4, for the lowest compared with the highest group) per 100 000 population. The reduction in tuberculosis treatment coverage was associated with higher COVID-19 incidence (adjusted odds ratio 11·7, 95% CI 1·5-93·4, for the highest compared with the lowest group), fewer primary health centres (10·6, 4·1-28·0, for the lowest compared with the middle-high group), and a very low number of doctors (0·3, 0·1-0·9, for the low-middle compared with the lowest group) per 100 000 population. No factors were shown to be significantly associated with all-cause mortality. The COVID-19 pandemic adversely and unevenly affected the national tuberculosis programme across Indonesia, with the greatest impacts observed in districts with the lowest health-system capacity. These disruptions could lead to an escalation in tuberculosis transmission in the coming years, warranting the need for intensified efforts to control tuberculosis and strengthen local health systems. Wellcome Africa Asia Programme Vietnam. For the Bahasa translation of the abstract see Supplementary Materials section.

Pulmonary mycoses among pulmonary tuberculosis in Kebbi State North Western Nigeria

BackgroundPathogenic fungi are the source of the fungal illness known as pulmonary mycosis. The prevalence of pulmonary mycoses among patients with pulmonary tuberculosis is continuously rising, despite improvements in the disease’s diagnosis, treatment, and management. Three hundred clinically confirmed patients with pulmonary tuberculosis were recruited for this study. Sputum samples were collected and analyzed to detect M. tuberculosis using the GeneXpert machine. Fungal elements were determined using microscopy, culture, and fungal biochemical analysis. Fungal isolates were confirmed using nested PCR with the internal transcribed sequence region of the ribosomal cistron of the fungal species.ResultsOf the 300 sputum samples analyzed, 50 (16.7%) patients had pulmonary tuberculosis. Fungi pathogens were found in 142 patients (47.3%), with 99/142 (71.2%) primary infections, and 40/139 (29.5%) secondary infections. Among the secondary infections, 33 (11%) were fungi coinfections with rifampicin-sensitive MTB coinfections, while 7 (2.3%) were fungi co-infected with rifampicin-resistant MTB. Candida albican was the most common fungus isolate, accounting for 44 (31.7%), while non-Candidal albicans accounted for only 2 (1.4%). Of the 99 species responsible for primary infection, 33 (23.7%) were Blastomyces precursors, 30 (21.6%) were Candida species, and 21 (15.1%) were Aspergillus fumigatus. The fungal pathogen with the highest frequency of secondary infection was Candida species 14 (10.1%), followed by Aspergillus fumigatus 11 (7.9%), then Blastomyces precursors, and then 09 (6.5%).ConclusionIn conclusion, this study determined the prevalence rate of fungal pathogens among pulmonary tuberculosis patients. The most dominant species observed were Blastomyces species, which are seldom reported in Africa and Nigeria. The two others were Aspergillus and Candida species. The study showed that a high percentage of cases of this species, responsible for pulmonary mycosis, were misdiagnosed and treated as pulmonary tuberculosis. Thus, there is a need for improved surveillance and accurate diagnosis of pulmonary infections for proper treatment.

Impact of anti-tuberculosis treatment on hematological parameters in newly diagnosed tuberculosis patients at Jimma town: a longitudinal prospective study.

This longitudinal prospective study was conducted from 03 January to 30 December 2019. Patients who completed a course of TB treatment were candidates for analysis. Sputum and blood samples were collected from each study participant and analyzed by the Gene X-pert machine and a HumaCount 30 hematology analyzer (Human GmbH). SPSS version 20 and R programming software version 4.2.3 were used for data analysis. Friedman's test was used to assess statistical significance. P-values ​​less than 0.05 were considered statistically significant. A total of 148 patients who completed the course of TB treatment correctly were a candidate for final analysis. Ninety-one (61.5%) study participants were male; the median age was 27.6±9.8 years. Moreover, most of the study participants (84.4%) had pulmonary TB. Most of the hematological parameters had changed in the phases of TB treatment. After anti-TB treatment, there is a significant difference in hematological parameters in red blood cell count, hemoglobin concentration, hematocrit percentage, platelet count, and white blood cell count. Anemia and leucopenia are the most significant problems after TB treatment. Regular checking of these parameters is essential for the patient.

Implementation of evidence-based multiple focus integrated intensified TB screening to end TB (EXIT-TB) package in East Africa: a qualitative study

IntroductionTuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care.ObjectiveWe present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up.MethodsA qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 in-depth interviews were conducted in Tanzania, Kenya, Uganda, and Ethiopia respectively. Data were transcribed and translated simultaneously and then thematically analysed.ResultsThe EXIT-TB project was described to contribute to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs. The attributes of TB case detection were: (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers. The supply-side challenges encountered ranged from disorganized care, limited space, the COVID-19 pandemic, inadequate human resources, inadequate knowledge and expertise, stock out of supplies, delayed maintenance of equipment, to absence of X-ray and GeneXpert machines in some facilities. The demand side challenges ranged from delayed care seeking, inadequate awareness, negative beliefs, fears towards screening, to financial challenges. Suggestions for scaling up ranged from improving service delivery, access to diagnostic equipment and supplies, and infrastructure, to addressing client fears and stigma.ConclusionThe EXIT-TB package appears to have contributed towards increasing TB case detection and reducing delays in TB treatment in the study settings. Addressing the challenges identified is needed to maximize the impact of the EXIT-TB intervention.

Breaking Down Barriers to the Implementation of the GeneXpert Technique: Perception of Healthcare Providers

Background:Tuberculosis control strategies globally aim to early detect and manage the disease. The GeneXpert assay has shown improved specificity and sensitivity over sputum smear microscopy. The assay shows comparable results to sputum culture and produces results in less than 2 hours making it a better diagnostic tool. We sought to identify barriers and challenges associated with the GeneXpert intervention in Ghana. &nbsp; Methods: This cross-sectional study was done between January and February 2022 and involved an online questionnaire (Google sheet, 2006) shared through WhatsApp with healthcare workers engaged in tuberculosis work in Ghana. The data collected was checked for completeness, coded, and entered into SPSS version 26 (IBM 2019) for analysis. Other analyses were done using GraphPad Prism 8 (Microsoft, 2019). Associations between demographic indicators, work-related characteristics, and choice of responses were explored using logistic regression models and generalized linear models. All analyses were two-tailed with p-values less than 0.05 being considered statistically significant &nbsp; Results: 294 health professionals participated in the study, the majority (51.4%) of whom were aged between 26-35 years and were mostly males (240/294). The majority of the respondents had attained their first degree (55.4%) with the rest having either certificates, diplomas, masters, or fellowships. Participants were mostly laboratory professionals (93.5%) who worked in either the district or municipal health facilities (37.8%). Most of them worked in public health facilities (&gt; 2/3), while the rest worked under the Christian Health Association of Ghana (CHAG), private and quasi-government facilities. The majority of the participants strongly agreed that module failure, delay in maintenance support, inadequate supply of cartridges, lack of appropriate centrifuges for non-pulmonary sample processing, poorly maintained air conditioners, and faulty UPS were associated with the optimal operation of the GeneXpert machines. &nbsp; Conclusion: GeneXpert is widely used in Ghana and has positively impacted TB case detection and management. Barriers such as faulty air conditioners, faulty UPS, module failure, inadequate cartridge supply, delay in maintenance support, and lack of equipment such as refrigerated centrifuge are affecting the effective implementation of the intervention. There is therefore an urgent need to tackle these barriers to forestall the failure of the intervention.

Zimbabwe's emergency response to COVID-19: Enhancing access and accelerating COVID-19 testing as the first line of defense against the COVID-19 pandemic.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spreads rapidly, causing outbreaks that grow exponentially within a short period before interventions are sought and effectively implemented. Testing is part of the first line of defense against Corona Virus Disease of 2019 (COVID-19), playing a critical role in the early identification and isolation of cases to slow transmission, provision of targeted care to those affected, and protection of health system operations. Laboratory tests for COVID-19 based on nucleic acid amplification techniques were rapidly developed in the early days of the pandemic, but such tests typically require sophisticated laboratory infrastructure and skilled staff. In March 2020, Zimbabwe confirmed its first case of COVID-19; this was followed by an increase in infection rates as the pandemic spread across the country, thus increasing the demand for testing. One national laboratory was set to test all the country's COVID-19 suspect cases, building pressure on human and financial resources. Staff burnout and longer turnaround times of more than 48 h were experienced, and results were released late for clinical relevance. Leveraging on existing PCR testing platforms, including GeneXpert machines, eased the pressure for a short period before facing the stockout of SARs-CoV-2 cartridges for a long time, leading to work overload at a few testing sites contributing to long turnaround times. On September 11, WHO released the interim guidance to use antigen rapid diagnostic test as a diagnostic tool. The Zimbabwe laboratory pillar quickly adopted it and made plans for its implementation. The National Microbiology Reference Laboratory verified the two emergency-listed kits, the Panbio Abbott and the Standard Q, Biosensor, and they met the WHO minimum performance of ≥97% specificity and ≥80% sensitivity. Decentralizing diagnostic testing leveraging existing human resources became a game-changer in improving COVID-19 containment measures. Task shifting through training on Antigen rapid diagnostic tests (Ag-RDT) commenced, and testing was decentralized to all the ten provinces, from 1 central testing laboratory to more than 1,000 testing centers. WhatsApp platforms made it easier for data to be reported from remote areas. Result turnaround times were improved to the same day, and accessibility to testing was enhanced.

Emerging Characteristic Profile of Patients on Multi-Drug Resistant Tuberculosis Treatment in Oyo State Drug-Resistant Tuberculosis Treatment Centres

Background: The global pandemic of tuberculosis has left everlasting scars on people’s lives. Drug-resistant tuberculosis is becoming an increasingly serious hazard to public health. With over 240,000 fatalities due to drug-resistant tuberculosis (DR-TB) worldwide, and Nigeria is one of the 14 nations with a significant multi-drug resistant TB burden, increased focus on dis-ease control is needed. Methods: The study was a retrospective cohort study. A total of 149 patients diagnosed using the gene Xpert machine and referred to the DR-TB treatment centers in University College Hospital and Government Chest Hospital were recruited. Data were collected from the patients’ case files and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Results: One hundred and forty-nine MDR-TB patients were enrolled in the study, of which 12.75% were new cases while 130 (87.2%) were on retreatment. The prevalence of MDR TB mortality was 4%. However, 30.9% had normal PCV at baseline while 68.5% of those enrolled had abnormal PCV. A total of 22(14.8 %) were reactive to the HIV test, while 125(83.9%) were not. At baseline, Body Mass Index (BMI) showed that 16.1% had a healthy weight, 18.1% were underweight, 2.7% were over-weight, and 59.7% were obese. At four months of treatment, BMI shows that 59.1% had healthy or normal weight, 12.8% were underweight, 6.0% were overweight, and 0.6% were obese. At four months, a significant association was observed between the baseline PCV, HIV status, hypertensive state, and the MDR-TB patient’s treatment outcome (p &lt; 0.05). Conclusion: The category of MDR TB patients had a significant outcome in the patient’s survival. New patients on treatment had better survival outcomes than retreatment cases. The baseline PCV and HIV status had a significant impact on the treatment outcome of the MDR-TB patients at four months of treatment TB. Also, good care needs to be intensified in MDR-TB patients that have HIV so as to improve the treatment outcome of such patients.

Feasibility of Find cases Actively, Separate safely and Treat effectively (FAST) strategy for early diagnosis of TB in Nepal: An implementation research.

Tuberculosis is one of the leading causes of death worldwide. Diagnosing TB in an early stage and initiating effective treatment is one of the best ways to reduce the burden of tuberculosis. Feasibility of Find cases Actively, Separate safely and Treat effectively (FAST) Strategy helps to improve the early diagnosis of tuberculosis cases among inpatient settings as well as out patient department patients and prevent TB transmission in hospital. This study aimed to assess the feasibility of the FAST strategy, organizational factors, technical factors, barriers and enablers for the proper implementation of the FAST strategy in Nepal. A qualitative study was conducted from April 2019 to August 2019. Data was collected by using focus group discussion, key informant interviews, and client exit interviews. A retrospective research was conducted in different hospitals in Nepal where FAST strategy was implemented. The patients, health care workers, province, district, and National level stakeholders were interviewed. Thematic analysis was used to assess the feasibility as well as barriers and enablers of the FAST strategy. Study identified that the 'current setting' of implementation and service delivery arrangement at hospitals were not well arranged as per requirements. The research findings showed hospital ownership is crucial for mobilizing staff and proper space management inside hospitals. Study identified that unavailability of a separate room, limited capacity of GeneXpert machine, irregular supply of GeneXpert cartridge, and insufficient human resources for screening and counseling are the major barriers of FAST implementation in Nepal. FAST strategy is feasible to implement in healthcare settings in Nepal although the technical and organizational factors should be managed to ensure effective function of the strategy as per the approach. Hospital ownership is essential to mobilize health workers, improve client flow system and proper space management for FAST services.

Adherence of HIV clinics to guidelines for the delivery of TB screening among people living with HIV/AIDS in Ghana

BackgroundTuberculosis screening of people living with HIV (PLHIV) – an intervention to reduce the burden of TB among PLHIV – is being implemented at HIV clinics in Ghana since 2007, but TB screening coverage remains low. Facility adherence to intervention guidelines may be a factor but is missing in implementation science literature. This study assesses the level of HIV clinic adherence to the guidelines and related facility characteristics in selected district hospitals in Ghana.MethodsThis cross-sectional study was conducted in all 27 district hospitals with HIV clinics, X-ray and geneXpert machines in Ghana. These hospitals are in 27 districts representing about 27% of the 100 district hospitals with HIV clinics in Ghana. A data collection tool with 18-items (maximum score of 29) was developed from the TB/HIV collaborative guidelines to assess facility adherence to four interrelated components of the TB screening programme as stated in the guidelines: intensive TB case-finding among PLHIV (ITCF), Isoniazid preventive therapy initiation (IPT), TB infection control (TIC), and programme review meetings (PRM). Data were collected through record review and interviews with 27 key informants from each hospital. Adherence scores per component were summed to determine an overall adherence score per facility and summarized using medians and converted to proportions. Facility characteristics were assessed and compared across facilities with high (above median) versus low (below median) overall adherence scores, using nonparametric test statistics.ResultsFrom the 27 key interviews and facility records reviewed, the median adherence scores for ITCF, IPT, TIC, and PRM components were 85.7% (IQR: 85.5–100.0), 0% (IQR: 0–66.7), 33.3% (IQR: 33.3–50.0), and 90.0% (IQR: 70.0–90.0), respectively. The overall median adherence score was 62.1% (IQR: 58.6–65.1), and 17 clinics (63%) with overall adherence score above the median were categorized as high adherence. Compared to low adherence facilities, high adherence facilities had statistically significant lower PLHIV clinic attendees per month (256 (IQR: 60–904) vs. 900 (IQR: 609–2622); p = 0.042), and lower HIV provider workloads (28.6 (IQR: 8.6–113) vs. 90 (IQR: 66.7–263.5); p = 0.046), and most had screening guidelines (76%, p < 0.01) and questionnaire (80%, p < 0.01) available on-site.ConclusionPRM had highest score while the IPT component had the lowest score. Almost a third of the facilities implemented the TB screening programme activities with a high level of adherence to the guidelines. We suggest to ensure adherence to all four components, reducing staff workloads and making TB screening questionnaires and guidelines available on-site would increase facility adherence to the intervention and ultimately achieve intervention targets.

Outcome of community-initiated treatment of drug-resistant tuberculosis patients in Lagos, Nigeria.

BackgroundWith the improvement in the capacity to diagnose multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) patients due to the increased number of GeneXpert machines in Nigeria, the number of patients diagnosed surpassed the bed capacity at MDR-TB treatment centres. Community DR-TB treatment is an important option to improve access to care for MDR/RR-TB patients. However, few studies have determined the outcome of community management of MDR-TB patients, which this study aims to address.MethodsWe conducted a retrospective study of MDR/RR-TB patients initiated on treatment in the community in Lagos, Nigeria, between 1 January 2015 and 31 December 2016. Data were retrieved from DR-TB treatment cards/registers. The treatment outcomes of these patients were assessed at the end of treatment and categorized according to national TB guidelines.ResultsA total of 150 DR-TB patients commenced treatment during the study period. Adherence was 64.7%, with the majority of patients experiencing mild (56.5%) adverse drug events. Treatment was successful in 70% of patients. The only predictor of successful treatment was treatment adherence.ConclusionsThe study shows that community initiation of MDR-TB treatment is feasible and results in a high treatment success rate. Adherence counselling before and during treatment is essential for a favourable treatment outcome.

Factors affecting viral load testing turnaround time in Malawi

Viral Load Testing (VLT) remains key in monitoring of HIV treatment. Despite being the gold standard test in disease monitoring, the tests face lengthy turnaround times in Malawi. With more people on ART, the demand for VLT has exponentially increased. Malawi faces a plethora of factors that enhance or hinder viral load testing. Some of the enlisted determinants and challenges include lack of molecular testing facilities, underutilization of GeneXpert machines for use in viral load testing, inconsistent specimen transport networks, procurement and supply chain management, and instrument downtime and functionality. These challenges have opened avenues for introduction of modifications to minimize turnaround times as would be desirable and eventually to reduce turnaround times and improve timely clinical management. This paper examines the status quo of viral loading testing in Malawi, highlights key areas affected by lengthy turnaround time in HIV management and presents recommendations on improving VLT turnaround time.

Factors Contributing to Low Tuberculosis Detection Rates among Children Accessing Health Services in Selected Public Sector Health Facilities in Zimbabwe

Introduction: Zimbabwe is one of 8 African countries with high per capita incidence of TB, TB/HIV and multi-drug resistant TB. Zimbabwe experienced a proportionate decline in childhood TB contribution to all notifications from 9% in 2011 to 5% in 2017. Methodology: Analytical cross-sectional study was conducted in 20 public sector health facilities. Data were collected from healthcare workers (HCWs) using structured questionnaires, interview guide for health managers and data abstraction tool for childhood TB data in registers. Protocol received ethical approval and written informed consent was obtained from participants. Results: Eighty-one HCWs and 18 managers were interviewed; data for 21,791 children were abstracted. About 3.1% of children were screened for TB, and 63.2% of presumptive TB children had TB diagnostic tests. A majority (71.9%) of TB tests were conducted on the Gen Xpert MTB Rif platform. Thirty-one out of 335 children with TB tests were diagnosed with TB, and 93.5% were initiated on treatment. Seven facilities offered TB testing, 5 had TB guidelines and 5 had pediatric TB job aides. Five out of 7 microscopes and 4/7 GeneXpert machines were functional. About 64.1% of HCWs had childhood TB training, 51% had ever received mentorship on childhood TB management, 53.1% had ever collected childhood TB diagnosis specimen and 23.3% had ever initiated children on TB treatment. Discussion: Childhood TB screening and diagnosis was suboptimal, and this was a result of low healthcare worker capacity, shortage and breakdown of TB diagnostic machines and weak TB diagnostic sample transportation system.

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

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.