Original Research

GeneXpert rollout in three high-burden tuberculosis countries in Africa: A review of pulmonary tuberculosis diagnosis and outcomes from 2001 to 2019

Victor Williams, Marianne Calnan, Bassey Edem, Chukwuemeka Onwuchekwa, Chika Okoro, Christine Candari, Rhodora Cruz, Kennedy Otwombe
African Journal of Laboratory Medicine | Vol 11, No 1 | a1811 | DOI: https://doi.org/10.4102/ajlm.v11i1.1811 | © 2022 Victor Williams, Marianne Calnan, Bassey Edem, Chukwuemeka Onwuchekwa, Chika Okoro, Christine Candari, Rhodora Cruz, Kennedy Otwombe | This work is licensed under CC Attribution 4.0
Submitted: 16 December 2021 | Published: 30 August 2022

About the author(s)

Victor Williams, Unit of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Marianne Calnan, University Research Co. LLC, Manila, Philippines
Bassey Edem, Vaccines and Immunity Theme, MRC Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia
Chukwuemeka Onwuchekwa, Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
Chika Okoro, Universal Health Coverage and Communicable and Non-Communicable Diseases Cluster, World Health Organization, Owerri, Imo State, Nigeria
Christine Candari, University Research Co. LLC, Manila, Philippines
Rhodora Cruz, University Research Co. LLC, Manila, Philippines
Kennedy Otwombe, Unit of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa


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Abstract

Background: The rollout of GeneXpert aimed at increasing early diagnosis of tuberculosis to improve treatment outcomes and global tuberculosis targets.

Objective: This study evaluated trends in tuberculosis diagnosis and outcomes pre- and post-introduction of GeneXpert in three African countries – the Democratic Republic of the Congo (DRC), Nigeria and South Africa.

Methods: Data from 2001 to 2019 were extracted from the World Health Organization’s data repository. Descriptive analysis, paired t-tests and interrupted time series models were used.

Results: Estimated tuberculosis incidence decreased from 327/100 000 to 324/100 000 in the DRC, and from 1220/100 000 to 988/100 000 in South Africa. Incidence remained at 219/100 000 in Nigeria. The tuberculosis case notification rate did not change significantly. Increases in the new case treatment success rates were statistically significant (DRC: p = 0.0201; Nigeria: p = 0.0001; South Africa: p = 0.0017); decreases in mortality were also statistically significant (DRC: p = 0.0264; Nigeria: p = 0.0001; South Africa: p < 0.0001). Time series models showed insignificant increases in new tuberculosis cases in DRC (n = 1856, p = 0.085) and Nigeria (n = 785, p = 0.555) from 2011 to 2019; and a statistically significant decrease in South Africa (n = 15 269, p = 0.006).

Conclusion: Improvements in tuberculosis treatment outcomes were achieved, but little progress has been made in new case notification due to varied implementation and scale-up of GeneXpert across the three countries. Implementation barriers need to be addressed to achieve the required tuberculosis targets.


Keywords

tuberculosis; GeneXpert; Xpert MTB/RIF; Africa; interrupted time series

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