Piloting upfront Xpert MTB/RIF testing on various specimens under programmatic conditions for diagnosis of TB & DR-TB in paediatric population
Abstract
Background
India accounts for
one-fifth of the global TB incidence. While the exact burden of
childhood TB is not known, TB remains one of the leading causes
of childhood mortality in India. Bacteriological confirmation of
TB in children is challenging due to difficulty in obtaining
quality specimens, in the absence of which diagnosis is largely
based on clinical judgement. While testing multiple specimens
can potentially contribute to higher proportion of laboratory
confirmed paediatric TB cases, lack of high sensitivity tests
adds to the diagnostic challenge. We describe here our
experiences in piloting upfront Xpert MTB/RIF testing, for
diagnosis of TB in paediatric population in respiratory and
extra pulmonary specimens, as recently recommended by WHO.
Method
Xpert MTB/RIF testing was
offered to all paediatric (0–14 years) presumptive TB
cases (both pulmonary and extra-pulmonary) seeking care at
public and private health facilities in the project areas
covering 4 cities of India.
Results
Under this pilot project,
8,370 paediatric presumptive TB & presumptive DR-TB cases
were tested between April and–November 2014. Overall,
9,149 specimens were tested, of which 4,445 (48.6%) were
non-sputum specimens. Xpert MTB/RIF gave 9,083 (99.2%, CI
99.0–99.4) valid results. Of the 8,143 presumptive TB
cases enrolled, 517 (6.3%, CI 5.8–6.9) were
bacteriologically confirmed. TB detection rates were two fold
higher with Xpert MTB/RIF as compared to smear microscopy.
Further, a total of 60 rifampicin resistant TB cases were
detected, of which 38 were detected among 512 presumptive TB
cases while 22 were detected amongst 227 presumptive DR-TB cases
tested under the project.
Conclusion
Xpert MTB/RIF with
advantages of quick turnaround testing-time, high proportion of
interpretable results and feasibility of rapid rollout,
substantially improved the diagnosis of bacteriologically
confirmed TB in children, while simultaneously detecting
rifampicin resistance.
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Source:
PLOS ONE
