Lessons Learned from Early Implementation and Scale-up of Stool-Based Xpert Testing to Diagnose Tuberculosis in Children

Abstract

In 2020, fecal (stool) testing was recommended for diagnosing Mycobacterium tuberculosis complex (MTBC) infection in children by using the Cepheid Xpert MTB/RIF assay; since then, countries have begun implementing stool-based testing, often as part of a comprehensive strategy to enhance TB case finding among children. On the basis of an experience-sharing workshop in November 2023, we determined insights of 9 early-adopter countries. Across those countries, 71,757 children underwent stool testing over a combined period of 121 months, October 2020–September 2023. A total of 2,892 children were positive for MTBC, and rifampin resistance was confirmed for 43 stool samples. The overall yield of MTBC detection across the countries was 4.1% (range 1.1%–17.3%). Stool collection for Xpert testing was considered noninvasive and as easy as sputum testing. Stool-based testing can be integrated into peripheral healthcare levels as a routine test to increase bacteriologic confirmation among children with presumptive TB.

Keywords

• tuberculosis
• Xpert MTB/RIF Ultra
• NTP
• stool
• fecal testing
• children