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Chapter 18 : Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control

Authors: Wendy Susan Stevens1, Lesley Scott2, Lara Noble3, Natasha Gous4, Keertan Dheda5
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Affiliations: 1: Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, and National Health Laboratory Service and National Priority Program of the National Health Laboratory Service, Johannesburg, South Africa; 2: Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; 3: Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; 4: Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, and National Health Laboratory Service and National Priority Program of the National Health Laboratory Service, Johannesburg, South Africa; 5: Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
Content Type: Monograph
Publication Year: 2017

Category: Microbial Genetics and Molecular Biology; Bacterial Pathogenesis

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Abstract:

Tuberculosis (TB) remains a global health security risk and a major cause of morbidity and mortality. The TB epidemic continues unabated, with 9.6 million infections occurring globally in 2014, coupled with an overall 1.5 million deaths ( ). Of these infected individuals, 12% were found to have concomitant human immunodeficiency virus (HIV) infection. While prevalence and incidence vary significantly across countries, the annual global incidence has decreased year after year since 2000 by an average of 1.5%. Twenty-two high-burden countries (HBCs) are responsible for 80% of all estimated incident TB cases. Alarmingly, one-third of all TB cases remain undiagnosed (or underreported), and the statistics are significantly worse for drug-resistant TB ( ). Reported multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) cases are inevitably on the rise as increased numbers of individuals are being diagnosed and treated, adherence remains unchecked or unsuccessful, and infection control practices remain suboptimal. Nearly half a million MDR-TB cases are diagnosed annually, representing less than a quarter of estimated incident cases ( ). There is significant work to be done to improve detection of drug-resistant TB and to ensure linkage to appropriate care of patients.

Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
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Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control
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Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
/content/10.1128/9781555819569.chap18.fig18-1
Figure 1

Diagram showing the phased implementation starting in high-burden districts.

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10.1128/9781555819569/fig18-1.gif
Image of Figure 1
Figure 1

Diagram showing the phased implementation starting in high-burden districts.

Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
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Figure 2

GeneXpert placement in 207 microscopy centers in South Africa.

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10.1128/9781555819569/fig18-2.gif
Image of Figure 2
Figure 2

GeneXpert placement in 207 microscopy centers in South Africa.

Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
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Figure 3

Innovations that accompanied the GeneXpert implementation in South Africa.

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Image of Figure 3
Figure 3

Innovations that accompanied the GeneXpert implementation in South Africa.

Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
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Figure 4

Cumulative risk curves based on Cox models using individual patient data for the key randomized control trials evaluating mortality associated with GeneXpert compared to smear microscopy.

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10.1128/9781555819569/fig18-4.gif
Image of Figure 4
Figure 4

Cumulative risk curves based on Cox models using individual patient data for the key randomized control trials evaluating mortality associated with GeneXpert compared to smear microscopy.

Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
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Tables

Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control
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Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
/content/10.1128/9781555819569.chap18.tab18-1
Table 1

NAAT-based TB technologies in the pipeline

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Table 1

NAAT-based TB technologies in the pipeline

Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
/content/10.1128/9781555819569.chap18.tab18-2
Table 2

Challenges experienced with large-scale implementation of GeneXpert technology and mitigation strategies

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Table 2

Challenges experienced with large-scale implementation of GeneXpert technology and mitigation strategies

Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016
/content/10.1128/9781555819569.chap18.tab18-3
Table 3

GeneXpert impact on treatment outcomes: review of studies

Generic image for table
Table 3

GeneXpert impact on treatment outcomes: review of studies

Citation: Stevens W, Scott L, Noble L, Gous N, Dheda K. 2017. Impact of the GeneXpert MTB/RIF Technology on Tuberculosis Control, p 389-410. In Jacobs, Jr. W, McShane H, Mizrahi V, Orme I (ed), Tuberculosis and the Tubercle Bacillus, Second Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TBTB2-0040-2016

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