Review Article

Rolling out Xpert MTB/RIF® for tuberculosis detection in HIV-positive populations: An opportunity for systems strengthening

Ishani Pathmanathan, Anand Date, William L. Coggin, John Nkengasong, Amy S. Piatek, Heather Alexander
African Journal of Laboratory Medicine | Vol 6, No 2 | a460 | DOI: https://doi.org/10.4102/ajlm.v6i2.460 | © 2017 Ishani Pathmanathan, Anand Date, William L. Coggin, John Nkengasong, Amy S. Piatek, Heather Alexander | This work is licensed under CC Attribution 4.0
Submitted: 06 April 2016 | Published: 31 March 2017

About the author(s)

Ishani Pathmanathan, Division of Global HIV and TB, US Centers for Disease Control & Prevention, Atlanta, Georgia and Epidemic Intelligence Service, US Centers for Disease Control & Prevention, Atlanta, Georgia, United States
Anand Date, Division of Global HIV and TB, US Centers for Disease Control & Prevention, Atlanta, Georgia, United States
William L. Coggin, Division of Global HIV and TB, US Centers for Disease Control & Prevention, Atlanta, Georgia, United States
John Nkengasong, Division of Global HIV and TB, US Centers for Disease Control & Prevention, Atlanta, Georgia, United States
Amy S. Piatek, Global Health Bureau, United States Agency for International Development, Washington DC, United States
Heather Alexander, Division of Global HIV and TB, US Centers for Disease Control & Prevention, Atlanta, Georgia, United States


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Abstract

Background: To eliminate preventable deaths, disease and suffering due to tuberculosis ,improved diagnostic capacity is critical. The Cepheid Xpert MTB/RIF® assay is recommended by the World Health Organization as the initial diagnostic test for people with suspected HIV associatedtuberculosis. However, despite high expectations, its scale-up in real-world settings has faced challenges, often due to the systems that support it.

Opportunities for System Strengthening: In this commentary, we discuss needs and opportunities for systems strengthening to support widespread scale-up of Xpert MTB/RIF as they relate to each step within the tuberculosis diagnostic cascade, from finding presumptive patients, to collecting, transporting and testing sputum specimens, to reporting and receiving results, to initiating and monitoring treatment and, ultimately, to ensuring successful and timely treatment and cure. Investments in evidence-based interventions at each step along the cascade and within the system as a whole will augment not only the utility of Xpert MTB/RIF, but also the successful implementation of future diagnostic tests.

Conclusion: Xpert MTB/RIF will only improve patient outcomes if optimally implemented within the context of strong tuberculosis programmes and systems. Roll-out of this technology to people living with HIV and others in resource-limited settings offers the opportunity to leverage current tuberculosis and HIV laboratory, diagnostic and programmatic investments, while also addressing challenges and strengthening coordination between laboratory systems, laboratory-programme interfaces, and tuberculosis-HIV programme interfaces. If successful, the benefits of this tool could extend beyond progress toward global End TB Strategy goals, to improve system-wide capacity for global disease detection and control.


Keywords

tuberculosis; Xpert MTB/RIF; laboratory systems strengthening

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