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allied
academies
September 20-21, 2017 | Philadelphia, USA
Global summit on
TUBERCULOSIS AND LUNG DISEASE
Int J Respir Med 2017 Volume 2 Issue 2
Background:
Since December 2010, WHO has endorsed Xpert MTB/RIF Assay for
the diagnosis of tuberculosis and rifampicin resistance tuberculosis. Based on this
recommendation, Ethiopia has been implementing the use of Xpert MTB/RIF Assay
since 2012. Monitoring and evaluation of Xpert MTB/RIF Assay implementation
is necessary to ensure the effective and efficient use of resources and to guide for
further scale-up.
Objective:
To assess implementation outcomes, gaps and staff profile after the
implementation of Xpert MTB/RIF Assay for the diagnosis of Tuberculosis and
Rifampicin resistant Tuberculosis in Ethiopia.
Methodology: Data was collected and analyzed from 87 GeneXpert sites from 15 May
to 11 June 2016. A structured questionnaire was used to collect information on staff
profile and trainings taken. Data was extracted from GeneXpert machine since the
date of installation from 70 GeneXpert sites. Records were reviewed from laboratory
register book and from archived laboratory request formats by using a comprehensive
assessment tool to evaluate the laboratory personnel competency and clinician’s
adherence to the national algorithm.
Result:
A total of 80,683 specimens were examined by using Xpert MTB/RIF
Assay starting from the date of installation up to June 2016 in 70 GeneXpert sites.
Mycobacterium tuberculosis
was detected in 12,422 (15.4%) of specimens. From all
Tuberculosis detected results 83.75% (10,403), 12.68% (1,591) and 3.45% (428) were
susceptible, resistance and indeterminate to Rifampicin respectively. The error rate
was 14.1%. There were 285 Xpert MTB/RIF Assay trained laboratory professionals at
87 GeneXpert sites. An average of 3 trained laboratory professionals were working
in each facility. At least one trained laboratory professional was found in each facility,
but untrained laboratory professionals were performing Xpert MTB/RIF Assay in 67
facilities. National Tuberculosis Program approved Xpert MTB/RIF Assay testing
algorithm was not followed in 36% of sites. Most of the clinicians did not properly
fill request papers. Standardized request formats and laboratory log books were not
available in 15% and 8% of facilities respectively. Xpert MTB/RIF Assay results were
correctly recorded on the laboratory log book in 87% of sites. Critical result (rifampicin
resistant tuberculosis) communication was not appropriate in 25.6% of facilities. Xpert
MTB/RIF Assay test results were not archived regularly in 47% of laboratories.
Conclusion:
Detection rate of tuberculosis with the Xpert MTB/RIF Assay was low; this
may be due to inappropriate requesting. Xpert MTB/RIF Assay showed an advantage
for detecting rifampicin resistant tuberculosis cases in peripheral laboratory level
which is important for early management of drug resistant tuberculosis. Error rate was
high as compared to the expected standard. There was 100% Xpert MTB/RIF Assay
training coverage. It was found that untrained laboratory professionals were doing
Xpert MTB/RIF Assay which may have a negative impact for the control of tuberculosis
and drug resistant tuberculosis.
e:
ayinalemal@gmail.comStatus of Xpert MTB/RIF assay implementation in Ethiopia
Ayinalem Alemu
Ethiopian Public Health Institute, Ethiopia