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Towards ending TB: Evolution of diagnostic tools and current strategies

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Towards ending TB: Evolution of diagnostic tools and current strategies



This week, the column takes a look at tuberculosis (TB) burden, strategies and tools used across the Zambezi River, our neighbours in the north, Zambia, with a population of 20.02 million (2022), and Ethiopia, with 120 million people, in East Africa.
The Ministry of Health in Zambia, together with partners, undertook an in country evaluation of TB.
Zambia has demonstrated massive reductions in new TB cases and associated mortality. However, there remains a significant need for improved TB care delivery. TB remains a leading cause of morbidity and mortality in Zambia, especially among people living with HIV.
In 2022, Zambia had a diagnostic network assessment conducted by the National TB & Leprosy Program (NTLP).
It revealed that hard-to-reach facilities lacked equitable access to the World Health Organisation (WHO) recommended molecular rapid diagnostic tests, e.g, GeneXpert and Truenat.
The WHO recommends the following first-line diagnostic tools for TB testing.
Rapid molecular diagnostic tests, such as GeneXpert, MTB/RIF Ultra, and Truenat assays, as the initial diagnostic test for all persons with signs and symptoms of TB.
Both tests can detect TB and rifampicin-resistant TB, but Truenat MTB/RIF DX is used as a follow-up test on samples that test positive for TB to test for rifampicin resistance.
Previously, sputum smear microscopy and culture testing, chest X-ray for the diagnosis of pulmonary TB were mainly used.
In 2016, the NTLP, Zambia, adopted the GeneXpert as its first line diagnostic tool in presumptive TB.
According to the 2021 Zambia Population-based HIV Impact Assessment (ZAMPHIA) survey, the HIV prevalence among adults 15+ years was 11.0%. HIV prevalence among women was 13.9%.
HIV prevalence among men was 8.0%. HIV incidence among women stands at 0.56%. HIV incidence among men was 0.06%.
Prevalence of viral load suppression (VLS) among adults living with HIV was 86.2%.
Meanwhile, a closer look at Ethiopia, showed the TB incidence at 126 per 100 000 people.
The TB burden and strategy in Ethiopia was given by Mr Getachew Aga Getachew Aga, Ministry of Health, Disease Prevention and Control General Manager in Goa, India. The meeting took place in May. The call to find all TB patients was organised by TB People India, in conjunction with TB People Zimbabwe, with funding support from Molbio Diagnostics.
“The total TB notification rate was high at 73% with 134,467 cases reported . We noted TB patient with documented HIV status at 85. There was linkage of TB HIV co-infected patients to ART service recorded at 72%.
“HIV positive cases that were newly enrolled and put on tuberculosis prevention therapy (TPT) were 64%, with a TB/HIV co infection rate of 5.2%. The number of TB/HIV mortality stood at 2100,” said Mr Getachew.
Speaking on multi-drug resistance, a total of 882 patients had multi drug resistance TB.
More than 37,000 people with TB are still missed in Ethiopia every year.
“Technical evaluation of Truenat machines was conducted in Ethiopia to generate global evidence. “Fifteen Truenat machines have been distributed to selected health facilities (HFs) for a feasibility study. “An additional 15 machines are in the pipeline for distribution.
“Molecular testing, specifically real-time PCR (polymerase chain reaction), is being expanded to health facilities, building on the experience of the Ethiopian Public Health Institute (EPHI) and the guidelines developed for GeneXpert MTB/RIF in 2013. The implementation includes integration with private facilities, mega projects, and Missionary of Charities. “Specimen transportation for referral is also being integrated into the program,” said Mr Getachew.
“The expansion aims to improve access to molecular diagnostics for TB in Ethiopia, enabling earlier detection and treatment of tuberculosis,” he added.
With science and innovation ushering efficient diagnostic tolls, civil society organisations must advocate for countries to purchase effective diagnostic tools and therapeutics for the treatment of TB.
TB can be treated and is curable.
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