EDCTP Alumni Network

Title

The impact of rapid genotypic detection of multi-drug resistant tuberculosis on treatment outcome in a semi-rural region of South Africa

Objectives

To determine whether the detection of tuberculosis by GeneXpert MTB/Rif testing in place of the routine diagnostic algorithm will lead to a reduction in: number of clinic visits prior to appropriate TB treatment; time to appropriate treatment for TB and reduced morbidity and mortality due to undiagnosed TB; number of TB cultures requested per patient; TB-related clinic workload and TB-related laboratory workload

Host Organisation

Institution	Country
University of Cape Town (UCT)	South Africa

Participants

Name	Institution	Country
Willem Hanekom	University of Cape Town (UCT)	South Africa
Gregory Hussey	University of Cape Town (UCT)	South Africa
Robert Wilkinson	University of Cape Town (UCT)	South Africa
Lizette Phillips	Brewelskloof Hospital	South Africa
Danie Theron	Brewelskloof Hospital	South Africa
Tommie Victor	Stellenbosch University	South Africa

Study Design

TB point of care diagnosis

Results & Outcomes

1577 patients with suspected TB were recruited. GeneXpert improves accuracy and shortens duration of diagnosis to treatment. The preliminary results of this study formed a substantial component of a report submitted to the WHO Strategic and Technical Advisory Group for Tuberculosis which in September 2010 issued a recommendation that Xpert MTB/RIF replace smear microscopy as the first line diagnostic test for TB in areas with high prevalence of MDR-TB or HIV. South-North networking in the project was well established working with the Foundation for Innovative New diagnostics (FIND) and TB Clinical Diagnostics Research Consortium of Johns Hopkins University and Boston Medical Centre. Other collaborative projects included development of a novel point-of-care diagnostics for TB with Northwestern University, USA. In the south the project links with EDCTP funded TB-NEAT consortium (PI Keertan Dheda), Wellcome Trust project in Malawi and Zimbabwe.

Publications

Boehme CC, Nicol MP, Nabeta P, Michael JS, Gotuzzo, Tahirli R, Gler MT, Blakemore R, Worodria W, Gray C, Huang L, Caceres T, Mehdiyev R, Raymond L, Whitelaw A, Sagadevan K, Alexander H, Albert H, Cobelens F, Cox H, Alland D, Perkins MD. Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert MTB/RIF test for diagnosis of tuberculosis and multidrug resis346ulticentrelticenter implementation study. Lancet. 2011 Apr 30;377(9776):1495-505