Improving MDR-TB diagnosis in Africa – the EXPAND TB experience

2nd December 2014

ASLM 2014 Cape Town, South Africa

Jesse Wambugu FIND

Background • ~9 million new TB infections in 2013

• 25% in the African region, highest rates of cases and deaths relative to population

• Only 58% of pulmonary TB patients bacteriologically confirmed

• 44,000 estimated MDR/RR cases in the African region in 2013; 32,480 cases notified (74%).

• But…..

• 26,023 (80%) of the cases were notified by South Africa

• Only 0.9% and 7.1% of new and previously treated patients had DST results in Africa

• XDR TB has been reported in at least 14 African

Methods • Project targeted at central and regional level labs

• Targeted technologies: liquid culture , DST, rapid speciation, LPA and Xpert (from 2012)

• 13,027 MDR TB cases were targeted by end 2014

Strengths • Ownership/buy-in from the MOH

• Strong links with the SNRL network

• Complementarity between project and in-country partners

• Long term TA through a large network of consultants

• Strong logistical support through GDF

Challenges • Poor/inadequate infrastructure in reference labs

• Long delays in customs clearance of goods

• Lack of equipment maintenance in project

• Staff turnover in reference labs

• Lack of effective Laboratory Information Management Systems (LIMS)

• Focus on national and regional labs only

• Gap between MDR TB diagnosis and treatment availability and initiation

Results

• 25 culture and LPA labs plus 12 GeneXpert labs operational

• 7,393 MDR cases diagnosed by June 2014

• 89 personnel have received training on MDR diagnosis and lab strengthening

• Market dynamics – decrease in price per test based on volumes procured

1 8

1

2

2

2

1 2

3 2

1

EXPanding

Access to

New

Diagnostics for

TB

MDR-TB patients diagnosed with support of EXPAND-TB project

2009-2014 (Q2) in Africa

25

Number of laboratories supported by the EXPAND-TB project

Djibouti - 178

Ethiopia - 2206

Uganda - 456

Kenya - 389

UR Tanzania - 149

Swaziland - 1008

Lesotho - 1093

Mozambique - 531

Rwanda - 64

Senegal - 121

Cameroon - 452

Côte d’Ivoire - 746

Republic of South Africa Sub Saharan Africa

EXPAND TB countries Non – EXPAND-TB countries

Next steps

Development and implementation of a transitioning strategy

• Focus on financing, quantification of needs and procurement

• Establishing links and formalizing relations between partners in laboratory strengthening

• Timeline

– Phase 1: piloted in Djibouti

– Phase 2: strategy initiated in 2013/2014 and closure of project in 2014 in Cameroon, Djibouti, Lesotho, Rwanda, Tanzania and Uganda

– Phase 3: closure of project in Cote d’Ivoire, Ethiopia, Kenya, Mozambique, Senegal and Swaziland in December 2015

Conclusion

Political commitment, a network of strong technical staff and strong collaboration amongst

partners are integral in improving access to quality MDR TB diagnosis in Africa.

• UNITAID – Daniela Vasile – Yamuna Mundade

• GLI / WHO – Fuad Mirzayev – Jean Iragena

• GDF – John Loeber – Thomas Verges – Fabienne Jouberton

• Country counterparts (MoH/NTP/NRL)

• SRLs

• FIND – Catharina Boehme – Daniel Orozco – Sandy Haldimann – Kekeletso Kao – C.N. Paramasivan – Alessandra Varga – Jeff Lemaire

• FIND Uganda team • FIND/GLI consultant network

ACKNOWLEDGEMENTS