The new technology GeneXpert available for treating TB patients in Bangladesh
A step forward to reduce disease burden
USAID supported TB Care II project implemented by University Research Co., LLC (URC) in Bangladesh introduced the GeneXpert MTB/RIF last month. GeneXpert is a cartridge-based, automated diagnostic test that can identify Mycobacterium tuberculosis (MTB) and resistance to rifampicin (RIF) cases. This technology and system was co-developed by Cepheid, Inc. and Foundation for Innovative New Diagnostics (FIND), with additional financial support from the US National Institutes of Health (NIH) and technical support from the University of Medicine and Dentistry of New Jersey (UMDNJ). The Gene Xpert is a new test for tuberculosis. It can find out if a person is infected with TB, and also if the TB bacterium of the person has resistance to one of the common TB drugs, rifampicin. In December 2010, the World Health Organization (WHO) endorsed the Xpert MTB/RIF for use in TB endemic countries and declared it a major milestone for global TB diagnosis.
In Bangladesh, Tuberculosis is a major public health problem. In 2006, WHO ranked Bangladesh sixth among the world’s 22 high-burden TB countries. More than 319,000 new cases, including 143,000 sputum smear-positive (SS+) pulmonary TB cases and 70,000 TB-related deaths occur annually. Limited studies to date suggest that the prevalence of multi-drug resistant tuberculosis (MDR-TB) is around 3% among newly diagnosed cases and 15% among previously treated patients in Bangladesh. The emergence of MDR-TB poses a significant threat to TB control activities throughout the world. In this situation, launching GeneXpert is a great initiative for improving the TB situation in Bangladesh and reducing disease burden.
Mr. Richard Greene Mission Director for USAID/Bangladesh, formally handing over a GeneXpert machine to Dr. Ruhul Haq the Minister of Health in a launching event.
The launch emphasized the need to improve detection and treatment of TB while also reducing costs. MDR treatment normally requires long hospital stays and costly treatment. With the new GeneXpert technology, accurate diagnosis of TB is given in two hours, compared to two months with existing technology. With quick detection, patients can start treatment the same day. The community-based treatment model reduces in-hospital treatment time to just two months, compared to 6-8 months. Upazila (sub-district) health workers then help patients manage care from home. These interventions lower overall costs by shortening hospital stays and reducing wait lists for TB hospital admission and save lives by providing faster, more accurate diagnosis.
In support of the National Tuberculosis Control Program (NTP), the project procured eight GeneXpert machines to be deployed at high-volume chest disease clinics nationwide. An additional four will arrive by the end of 2012. The TB Care II project is complementing the national tuberculosis control program through a public-private partner approach.
How the test works
The Xpert MTB/RIF detects DNA sequences specific for Mycobacterium tuberculosis and rifampicin resistance by polymerase chain reaction. It is based on the Cepheid GeneXpert system, a platform for rapid and simple-to-use nucleic acid amplification tests (NAAT). The Xpert® MTB/RIF purifies, concentrates, amplifies (by real-time PCR) and identifies targeted nucleic acid sequences in the Mycobacterium tuberculosis genome, and provides results from unprocessed sputum samples in 90 minutes, with minimal biohazard and very little technical training required to operate.