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. 2018 Sep 21;8(3):124-129.
doi: 10.5588/pha.18.0028.

Has the utilisation of Xpert® MTB/RIF in Manicaland Province, Zimbabwe, improved with new guidance on whom to test?

A Jokwiro  1 , C Timire  2   3 , A D Harries  4   5 , P T Gwinji  1 , A Mulema  1 , K C Takarinda  2 , P T Mafaune  6 , C Sandy  3
Affiliations

Has the utilisation of Xpert® MTB/RIF in Manicaland Province, Zimbabwe, improved with new guidance on whom to test?

A Jokwiro et al. Public Health Action. .

Abstract
in English, French, Spanish

Setting: Manicaland Province, Zimbabwe. Objectives: To compare the utilisation and results of deploying Xpert® MTB/RIF in 13 (one provincial, six district and six rural) hospitals between January and June 2016, when Xpert was recommended only for those with presumptive multidrug-resistant tuberculosis (MDR-TB) and coinfection with human immunodeficiency virus (HIV), and between January and June 2017, when Xpert was recommended for all presumptive TB patients. Design: This was a cross-sectional study. Results: Xpert assays averaged 759 monthly in 2016 and 1430 monthly in 2017 (88% increase). Utilisation of Xpert averaged 22% monthly in 2016 and 42% in 2017 (88% increase). In 2017, utilisation of Xpert was significantly higher in provincial (82%) than in district (51%) and rural (26%) hospitals (P < 0.001). The proportion of successful assays that detected TB decreased significantly from 13% in 2016 to 7% in 2017 (a 46% decrease, P < 0.001); this phenomenon was observed in all types of hospital. The proportion of persons detected with rifampicin-resistant TB was similar between hospitals (4% in 2016 and 3% in 2017). The proportion of registered TB cases with bacteriological confirmation increased from 48% in 2016 to 53% in 2017 (P = 0.04). Conclusion: Xpert use in all presumptive TB patients led to a significant increase in assay numbers and utilisation of Xpert instruments, resulting in more bacteriological confirmation of cases.

Contexte : Province de Manicaland, Zimbabwe.Objectif : Comparer l'utilisation et les résultats du déploiement de l'Xpert® MTB/RIF dans 13 hôpitaux (1 provincial, 6 de district et 6 ruraux) entre janvier et juin 2016, quand l'Xpert a été recommandé seulement pour les patients ayant une présomption de la tuberculose (TB) multirésistante et une coinfection par le virus de l'immunodéficience humaine, et de janvier à juin 2017, quand l'Xpert a été recommandé pour tous les patients présumés TB.Schéma : Etude transversale.Résultats : Le nombre moyen de tests Xpert a été de 759 par mois en 2016 et de 1430 par mois en 2017 (augmentation de 88%). L'utilisation de l'instrument a été d'environ 22% par mois en 2016 et de 42% en 2017 (augmentation de 88%). En 2017, l'utilisation de l'instrument a été significativement plus élevée dans l'hôpital provincial (82%) comparé aux hôpitaux de district et ruraux (51% contre 26% ; P < 0,001). La proportion de succès des tests qui ont détecté une TB a significativement diminué de 13% en 2016 à 7% en 2017 (diminution de 46% ; P < 0,001) ; ceci a été observé dans tous les types d'hôpitaux. Les proportions de TB résistantes à la rifampicine ont été similaires entre les hôpitaux (4% en 2016 et 3% en 2017). La proportion des cas de TB enregistrés avec une confirmation bactériologique a augmenté de 48% en 2016 à 53% en 2017 (P = 0,04).Conclusion : L'utilisation du Xpert pour tous les patients présumés TB, les nombres de tests et l'utilisation de l'instrument Xpert ont significativement augmenté, aboutissant à davantage de confirmation bactériologique des cas.

Marco de referencia: La provincia de Manicaland, en Zimbabwe.Objetivos: Comparar la utilización de los dispositivos Xpert® MTB/RIF y los resultados de su despliegue en 13 hospitales (1 de provincia, 6 distritales y 6 rurales) durante dos períodos: de enero a junio del 2016, cuando se recomendaba la prueba Xpert solo en los casos de presunción de tuberculosis (TB) multirresistente y coinfección por el virus de la inmunodeficiencia humana, y de enero a junio del 2017, cuando se recomendaba la prueba Xpert en todos los pacientes con presunción de TB.Objetivos: Fue este un estudio transversal.Resultados: El promedio mensual de pruebas Xpert fue 759 en el 2016 y 1430 en el 2017 (un aumento del 88%). El porcentaje de utilización de los dispositivos Xpert fue en promedio 22% mensual en el 2016 y 42% en el 2017 (un aumento del 88%). En el 2017, la utilización de los dispositivos Xpert fue significativamente mayor en los hospitales de provincia (82%) comparados con los hospitales distritales y los rurales (51% contra 26%; P < 0,001). La proporción de análisis eficaces que detectaban la TB disminuyó de manera notable de 13% en el 2016 a 7% en el 2017 (una disminución del 46%; P < 0,001); esta situación se observó en todos los tipos de hospitales. La proporción de casos detectados de TB con resistencia a rifampicina fue equivalente en todos los hospitales (4% en el 2016 y 3% en el 2017). La proporción de casos de TB con confirmación bacteriológica registrados aumentó del 48% en el 2016 al 53% en el 2017 (P = 0,04).Conclusión: Al utilizar la prueba Xpert en todos los pacientes con presunción clínica de TB se aumentó considerablemente el número de pruebas y la utilización de los dispositivos Xpert, lo cual ha dado lugar a una mayor proporción de casos con confirmación bacteriológica.

Keywords: SORT IT; TB; Xpert® MTB/RIF; rifampicin-resistant TB.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

FIGURE 1
FIGURE 1
Number of Xpert® MTB/RIF assays performed each month in Manicaland Province, Zimbabwe, January–June 2016 and January–June 2017. The instrument was non-functional in two hospitals (Birchenough and Chipinge) between March and May 2016 and in two hospitals (Makoni and Bonda) between April and May 2017.
FIGURE 2
FIGURE 2
Utilisation rates* of Xpert® MTB/RIF instruments per month in Manicaland Province, Zimbabwe, January–June 2016 and January–June 2017. The instrument was non-functional in two hospitals (Birchenough and Chipinge) between March and May 2016 and in two hospitals (Makoni and Bonda) between April and May 2017. *Utilisation rates were calculated by dividing the total number of assays by the total number of expected assays. The number of expected assays per instrument per month was 264, based on a four-module machine with a throughput of 12 assays/day and an average of 22 working days/month. An 8 h working day model was assumed.
See this image and copyright information in PMC

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