The executive board of UNITAID has approved funding of $30 million to rollout the Gene Xpert machine to scale up TB diagnosis in 20 countries. In addition, the Stop TB Partnership initiative TB REACH will co-fund up to $10 million to support implementation of the TB tests in countries, bringing the total amount committed to $40 million.
This is very exciting news considering that most developing countries still diagnose TB by looking at a sputum sample under a microscope – a method that only detects about half of all cases and cannot identify drug resistant strains of TB. GeneXpert MTB/RIF is a relatively new and rapid diagnostic tool that was endorsed by the WHO in December 2010.
Xpert detects close to 80% of TB cases within two hours and is able to identify resistance to the drug rifampicin, one of the main first-line drugs used to treat TB. Being able to detect resistance to rifampicin is also a strong indicator for multi-drug resistance, meaning a greater number of multi-drug resistant TB (MDR-TB) cases will be found. Prior to Xpert, the only way to determine if a patient had drug resistant TB was to grow a bacteria culture, which can take weeks for results, meaning patients return to their communities and potentially infect others before receiving a diagnosis.
During RESULTS UK’s delegation to South Africa in February, we were told by doctors at the Prince Mshiyeni Memorial Hospital in KwaZulu-Natal, a province with very high rates of TB and drug resistant TB, that Xpert will “completely revolutionise” the way the world diagnoses TB.
In addition to funding rollout of the machines, UNITAID has also reached an agreement with the manufacturer of Xpert that will significantly reduce the price of diagnostic cartridges from $17 to less than $10.
UNITAID is a global health financing mechanism that was established in 2006. It provides tools to prevent, diagnose and treat TB, HIV and malaria to 94 low and middle income countries. It uses a targeted market approach to provide quality low cost diagnostics and medicines to those who need them the most.
TB REACH is currently supported by the Canadian Government and provides funding for TB projects aiming to increase TB detection and has been the single largest supporter of Xpert rollout to date.
How often these days are we replacing our technological gadgets? If we have a cellphone older than a couple of years, for example, then the hardware is surely considered “past it”.
Well, in the fight against TB we have recently had the launch of GeneXpert, a new DNA-based test that is more accurate and much faster for detecting TB than the previous method – which uses a microscope and was first used 120 years ago! The even better news is that this new test is especially accurate in children and in those who are living with HIV, for whom the old method is particularly ineffective.
The ACTION Partnership has created a new video that talks about GeneXpert, and has entered it to the InTB Contest. Take two minutes and seven seconds to watch the video, learn about this new machine, and then Tweet, Facebook, and LinkedIn to help ACTION’s video win the competition!
Watch the video here. Oh, and while you’re there you may want to look at some of the other excellent entries too, like this one on TB in Mining in South Africa, by Jonathan Smith, and the subject of a recent All-Party Parliamentary Group on Tuberculosis event.
Today we feature the third of our four competition runner up entries. This piece comes from Prudence Jarrett.
“Prudence a fifth year medical student, currently studying for a BSc in International Health before finishing my medical training. Her interests are in global health and development, HIV and infectious diseases. In the future she plans to work for humanitarian aid organisations, as well as carry research and clinical work in infectious diseases in developing countries”
Tuberculosis: Diagnosing the future
Patience sits outside on a straw mat, ankles crossed, her back against the cool mud and wattle wall of her family home, helping her aunt snap beans for dinner in the hot dry hills of northern KwaZulu-Natal. She has grown thin and tired and is unable to work for long, preferring to lie on her side so the coughing hurts less.
No healthcare workers have been to the village recently, and, even if they had she thinks to herself, it might be months before they could treat her. Patience is not a real girl, but I have met ones like her. She represents one of the nine million people who were infected with tuberculosis in 2010 but hopefully not one of the more than a million of those who will die.
Tuberculosis is a disease symptomatic of poverty, but unlike some other infectious diseases, such as river blindness, where one simple intervention can save millions of lives, barriers to TB eradication lie at multiple levels. Drugs in use haven’t changed for decades and the vaccine remains only partially effective.
Another barrier is quick and accurate diagnosis. Current diagnostic techniques for TB are time-consuming and reliant on trained lab technicians and a well-co-ordinated health system. On getting to a health centre, which may be an expensive and exhausting distance away, Patience will have to provide several sputum samples, coughed up into little pots that are sent to the nearest laboratory.
This week the World Health Organization endorsed a new tuberculosis (TB) test called Xpert MTB/RIF. Xpert is a revolutionary new technology that, if taken to scale in endemic countries, could completely change the public health approach to diagnosing and treating TB, which remains one of the greatest killers on the planet.
Xpert: Better than X-Rays
Xpert provides a rapid, accurate diagnosis of TB without the need for a sophisticated lab. It detects many cases that are missed by current technology, which is more than a century old, including for people who are HIV positive — where TB mortality is highest and where the majority of cases are missed by current frontline tools. Rapid diagnosis will allow patients to start appropriate treatment in hours as opposed to weeks or even months. Since over a quarter of all AIDS-related deaths are caused by TB, Xpert is a critical tool in the fight against AIDS as well. Continue reading