Fondation Merieux

A family foundation dedicated to fighting infectious diseases

ExpandTB Haiti: New tools implementation for TB / MDR TB detection

7 February 2012, Lyon (France)

The ExpandTB programme, funded by UNITAID and coordinated by FIND, was launched in 2008 by the organization StopTB.

ExpandTB Haiti: New tools implementation for <abbr title="Tuberculosis">TB</abbr> / <abbr title="MultiDrug Resistant">MDR</abbr> TB detection

Its overall objective is to improve the detection of TB and MDR TB in countries with a high prevalence of TB. Its main strategic focus involves the use of new laboratory tools, such as liquid media and DST (MGIT system, BD), molecular LiPA (MTBDRplus and MTBDRsl, Hain), and immunochromatographic testing to identify the M. tuberculosis complex (Capilia, Tauns), all of which are intended to be appropriately included in the diagnostic algorithm of TB / MDR TB.

In 2009, Haiti was designated as one of the countries eligible to participate to this program. Once these new laboratory tests are validated, Haitian partners (GHESKIO and LNSP) will be able to benefit from a 3-year cost-free supply of reagents through the ExpandTB programme, and will be able to demonstrate the need for these new tests to be incorporated into the national detection algorithm of TB / MDR TB. GHESKIO was designated as the first institution to put these technologies into use on account of its close relationship with national health programs, and is being the sole facility able to performe TB cultures. FIND and Fondation Mérieux co-managed this study.

The technical validation study was carried out on 200 microscopy smear positive samples. Cultures carried out in liquid media confirmed a higher sensitivity rate and a shorter turnaround time than on solid media for an equivalent cost. DST and LiPA testing resulted in the detection of 14 samples with MDR, i.e. resistance to rifampin and isoniazid. LiPA testing significantly saved time and costs compared to DST, which is nevertheless still necessary in order to confirm results and obtain an accurate antibiotics sensitivity profile. With the use of these tests, the diagnosis of TB / MDR TB is shortened to 2-3 weeks, compared to the lagtime of 2-3 months with traditional testing (solid media). A more rapid detection of TB MDR will lead to improve patients healthcare, who can be treated sooner with better-adapted medication. The next step is to put greater emphasis on setting up a strategy for screening MDR TB, and this will help expand the capacity of providing second-line treatment.

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