PLoS ONE (Jan 2020)

Upfront Xpert MTB/RIF for diagnosis of pediatric TB-Does it work? Experience from India.

  • Aakshi Kalra,
  • Debadutta Parija,
  • Neeraj Raizada,
  • K S Sachdeva,
  • Raghuram Rao,
  • Soumya Swaminathan,
  • Ashwani Khanna,
  • Kamal Kishore Chopra,
  • M Hanif,
  • Varinder Singh,
  • K R Umadevi,
  • K N Sheladia,
  • Rama Rao,
  • N Vasundhara,
  • Anil S,
  • Nirmala A R,
  • Abdul Azeem,
  • Vijay Chhajlani,
  • Jyoti Khurana,
  • N J Das,
  • Bandana Choudhury,
  • Sreenivas Achuthan Nair,
  • Shalini Mall,
  • Rajashree Sen,
  • Sarabjit Singh Chadha,
  • Claudia M Denkinger,
  • Catharina Boehme,
  • Sanjay Sarin

DOI
https://doi.org/10.1371/journal.pone.0236057
Journal volume & issue
Vol. 15, no. 8
p. e0236057

Abstract

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BackgroundDiagnosis 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.MethodsData 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.ResultsOf 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).ConclusionThis 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.