Open AccessUpfront Xpert MTB/RIF for diagnosis of pediatric TB—Does it work? Experience from India
Author(s) -
Amit Kalra,
Debadutta Parija,
Neeraj Raizada,
Kuldeep Singh Sachdeva,
Raghuram Rao,
Soumya Swaminathan,
Ashwani Khanna,
K.K. Chopra,
Mahmud Hanif,
Varinder Singh,
K. R. Umadevi,
K. N. Sheladia,
Rama Rao,
N. Vasundhara,
Anil Singarajipura,
A R Nirmala,
Abdul Azeem,
Vijay Chhajlani,
Jyoti Khurana,
Neeladrisingha Das,
Bandana Choudhury,
Sreenivas Achuthan Nair,
Shalini Mall,
Rajashree Sen,
Sarabjit Chadha,
Claudia M. Denkinger,
Catharina Boehme,
Sanjay Sarin
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0236057
Subject(s) - medicine , tuberculosis , sputum , population , case finding , medical emergency , emergency medicine , pediatrics , family medicine , environmental health , pathology
Background Diagnosis of TB in pediatric population poses several challenges. A novel initiative was implemented in several major cities of India aimed at providing upfront access to free-of-cost Xpert MTB/RIF to presumptive pediatric TB cases. This paper aims to describe the experience of implementing this large initiative and assess feasibility of the intervention in high TB burden settings. Methods Data were drawn from the pediatric TB project implemented in 10 major cities of India between April 2014 and March 2018. In each city, providers, both public and private, were engaged and linked with a high throughput Xpert MTB/RIF lab (established in that city) through rapid specimen transportation and electronic reporting system. Rates and proportions were estimated to describe the characteristics of this cohort. Results Of the total 94,415 presumptive pediatric TB cases tested in the project, 6,270 were diagnosed positive for MTB (6.6%) on Xpert MTB/RIF (vs 2% on smear microscopy). Among MTB positives, 545 cases were rifampicin resistant (8.7%). The median duration between collection of specimens and reporting of results was 0 days (same day) and >89% cases were initiated on treatment. Approximately 50% of the specimens tested were non-sputum. The number of providers/facilities engaged under the project increased >10-fold (from 124 in Q2’14 to 1416 in Q1’18). Conclusion This project, which was one of the largest initiatives globally among pediatric population, demonstrated the feasibility of sustaining rapid and upfront access to free-of-cost Xpert MTB/RIF testing. The project underscores the efficiency of this rapid diagnostic assay in tackling several challenges in pediatric TB diagnosis, identifies opportunities for further interventions as well as brings to light scope for effective engagement with healthcare providers. The findings have facilitated a policy decision by National TB Programme mandating the use of Xpert MTB/RIF as a primary diagnostic tool for TB diagnosis in children, which is being scaled-up.