Technology supported systems for rapid impact on TB control

Delivery of diagnostic services that serve the population well depends upon the availability of high quality diagnostic tests and of laboratory systems that are able to prioritise efforts in regions of particular need and respond to changes in the distribution of that need. South Africa has pioneered widespread introduction of a new test for tuberculosis (TB) called Xpert MTB/RIF which runs on a platform called Genexpert that has capability both for connectivity to a central laboratory facility and for testing for things other than just TB. This means that the National Health Laboratory Service is able to identify where there are increases in people being diagnosed with TB, and potentially also follow trends in other infectious diseases such as HIV. In addition, this network provides the opportunity to test the performance of new and improved tests for infectious diseases, including TB, with the ultimate goal of improving patient care.

The National Priority Program (NPP) of the National Health Laboratory Service was formalized in 2010 to address the National Department of Health’s (NDoH) need to provide increased access to patient testing to enhance care programs, with a focus on HIV and TB and other opportunistic infections. Strength of this program is its national footprint of laboratory analyzers that are all interfaced via a laboratory information system (LIS). This data is reviewed centrally and provides the backbone to monitoring and evaluation of NDoH treatment programs. The LIS and other data connectivity tools, provides the basis for identifying trends in disease prevalence, “hot spots” of transmission, the impact of interventions and regions of poor service coverage. In particular this group’s implementation model for pulmonary TB testing using the GeneXpert platform has become a globally accepted approach. These implementation models require refining to improve current practice (especially for MDR/XDR TB diagnosis), modification with the introduction of the more sensitive GeneXpert Ultra test and integration with HIV through exploration of the polyvalent capabilities of the GeneXpert platform and expansion to vulnerable populations.

The anticipated outcomes of the three year project and collaboration are to implement the
mapping systems to impact on patient care and deliver models that will improve patient care and linkage to treatment as well as reduce costs while improving and integrating service delivery.

Three milestones have been identified: (i) primarily to deliver system mapping tools (a national dashboard for monitoring and evaluation; a real-time operational dashboard for improved laboratory service delivery; a novel real-time molecular epidemiology dashboard to target interventions); and secondarily (ii) to streamline diagnostic algorithms to increase rapid TB detection, drug resistance and reduce program costs; and (iii) to integrate TB and HIV service delivery using polyvalent diagnostic testing platforms to meet sustainable development goals.

Four goals have been identified for this study in order to achieve the milestones
1 - to optimize connectivity platforms to ensure optimal reporting of
relevant TB disease indicators and optimize “real-time” laboratory quality indicators and thereby improve TB control.

2 - to evaluate new diagnostics for TB and MDRTB to improve
patient diagnosis and develop cost-effective laboratory diagnostic and treatment algorithms.

3 - to further evaluate these diagnostic platforms for polyvalent
capabilities to integrate and optimize TB and HIV patient care and service.

4 - to develop and propose policy using the connectivity mapping tools to optimize current services and models of new and integrated diagnostics to improve services.