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Optimising molecular diagnostic capacity for effective control of tuberculosis in high-burden settings

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Date
01/08/2016
Author
Sabiiti, Wilber
Mtafya, Bariki
Kuchaka, Davis
Azam, Khalide
Viegas, Sofia
Mdolo, Aaron
Farmer, Eoghan
Khonga, Margaret
Evangelopoulos, Dimitrios
Honeyborne, Isobella
Rachow, Andrea
Heinrich, Norbert
Ntinginya, Nyanda Elias
Bhatt, Nilesh
Davies, Gerry R
Jani, Ilesh V
McHugh, Timothy D
Kibiki, Gibson
Hoelscher, Michael
Gillespie, Stephen Henry
PANBIOME (Pan-African Biomarker Expansion Programme) consortium
Keywords
Tuberculosis
Diagnostics
Health systems
Policy
Disease control
RA0421 Public health. Hygiene. Preventive Medicine
NDAS
SDG 3 - Good Health and Well-being
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Abstract
The World Health Organization's 2035 vision is to reduce tuberculosis (TB) associated mortality by 95%. While low-burden, well-equipped industrialised economies can expect to see this goal achieved, it is challenging in the low- and middle-income countries that bear the highest burden of TB. Inadequate diagnosis leads to inappropriate treatment and poor clinical outcomes. The roll-out of the Xpert® MTB/RIF assay has demonstrated that molecular diagnostics can produce rapid diagnosis and treatment initiation. Strong molecular services are still limited to regional or national centres. The delay in implementation is due partly to resources, and partly to the suggestion that such techniques are too challenging for widespread implementation. We have successfully implemented a molecular tool for rapid monitoring of patient treatment response to anti-tuberculosis treatment in three high TB burden countries in Africa. We discuss here the challenges facing TB diagnosis and treatment monitoring, and draw from our experience in establishing molecular treatment monitoring platforms to provide practical insights into successful optimisation of molecular diagnostic capacity in resource-constrained, high TB burden settings. We recommend a holistic health system-wide approach for molecular diagnostic capacity development, addressing human resource training, institutional capacity development, streamlined procurement systems, and engagement with the public, policy makers and implementers of TB control programmes.
Citation
Sabiiti , W , Mtafya , B , Kuchaka , D , Azam , K , Viegas , S , Mdolo , A , Farmer , E , Khonga , M , Evangelopoulos , D , Honeyborne , I , Rachow , A , Heinrich , N , Ntinginya , N E , Bhatt , N , Davies , G R , Jani , I V , McHugh , T D , Kibiki , G , Hoelscher , M , Gillespie , S H & PANBIOME (Pan-African Biomarker Expansion Programme) consortium 2016 , ' Optimising molecular diagnostic capacity for effective control of tuberculosis in high-burden settings ' , International Journal of Tuberculosis and Lung Disease , vol. 20 , no. 8 , pp. 1004-1009 . https://doi.org/10.5588/ijtld.15.0951
Publication
International Journal of Tuberculosis and Lung Disease
Status
Peer reviewed
DOI
https://doi.org/10.5588/ijtld.15.0951
ISSN
1027-3719
Type
Journal article
Rights
© 2016 the Union. This work is made available online in accordance with the publisher’s policies. This is the author created, accepted version manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at http://dx.doi.org/10.5588/ijtld.15.0951
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  • University of St Andrews Research
URI
http://hdl.handle.net/10023/10447

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