PIH Experience with Gene Expert 2011 Presentation to NTP

High cost of Xpert MTB/RIF testing pertuberculosis case diagnosed atPartners in Hope Medical Center, a publicprivate HIV care clinic in Lilongwe, Malawi. Comparison with fluorescence microscopy in a well-equipped and experienced real world AFB laboratory

D. Fitzgerald1,2, P. Jansen1, C. Chipungu1, V. Dindi1, J. Fielder1, C. Pfaff1,21Partners in Hope, Lilongwe, Malawi, 2University of California, Los Angeles, Program in Global Health, Los Angeles, United States

EQUIP-MALAWI

1Background - Malawi Population 15 millionHIV prevalence 12-15%TB prevalence 219/100 000TB patients HIV Positive - 63%Per capita health expenditure $50

Partners in Hope Medical CenterPublic private clinic - 4300 HIV patients. TB diagnosis and treatment centerAFB microscopyCulture not routinely available

Introduction of Xpert MTB/RIF Xpert machine donated Aug 2011Donation of near expiration date cartridges - ability to increase testing of TB suspects

Introduction of Xpert MTB/RIFPopulation: All HIV(+) patients seen at Partners in Hope who were identified as TB suspects Suspicion of possibility TB by experienced clinician based on history and examinationLab: 1 Xpert test and 2 AFB smearsXpert testing - morning samples AFB smears mixed

ObjectivesDescribe in somewhat ideal real-world setting how to best use Xpert to improve TB case findingPercent of smear (-) sputum samples with (+) Xpert Number of smear (-) sputum samples that need to be tested to yield one (+) XpertCost of Xpert testing per smear (-) case detected (using AFB smear as initial test per Malawi draft Xpert guidelines)MethodsRetrospective review of the AFB laboratory recordsclinical data not collected only included sputum samples

Methods smear definitionsSamples - positive, negative or scanty (