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Notes From the Field: TB REACH in Mozambique

Posted: Sep 12, 2013 · Posted by: Jamie Cowan, HAI Technical Advisor for Operations Research and Implementation Science

Diagnosing and treating tuberculosis (TB) in central Mozambique is a challenging yet critical task. As the leading cause of death in patients with HIV, TB rates have increased dramatically over the last two decades during the HIV epidemic in sub-Saharan Africa. Unfortunately our ability to appropriately diagnose and treat TB in central Mozambique has not kept pace.

The tides may be starting to shift, however, with the introduction of exciting new diagnostic platforms, and a renewed commitment on the global and national level to address the TB epidemic.

At HAI we are honored to be part of this process, and have been working closely with the TB teams in Manica and Sofala to pilot the GeneXpert MTB/rif (Xpert) platform and LED microscopes. Supported by a grant from WHO/TB REACH described here (link to project description), we are well into our second year and have witnessed first hand the impact of this new technology.

Our dedicated TB team, spearheaded by Claudio Monivo and Desiderio Saize, has spent the last 18 months implementing 5 Xpert machines and 10 LED microscopes in public sector hospital and health center laboratories. This has involved training hundreds of laboratory technicians and providers on how to use these platforms, and interpret the results. We have seen firsthand how Xpert and LED microscopy dramatically increase the number of patients that we can diagnose with pulmonary TB. By identifying and treating these patients early we can help eliminate the spread of TB in the surrounding communities.

While our early results are encouraging, many challenges remain. Over the last few months we have spent significant time maintaining and repairing the first generation Xpert platform. While the underlying technology is a significant breakthrough, we need a less expensive and more robust machine that can withstand the heat, dust, and intermittent electricity in central Mozambique. Fortunately several companies are developing the next generation platform for this technology.

Secondly, while improved technology for diagnosis is important, we also need to strengthen the entire TB care cascade. This year we are working closely with the Mozambican TB program to develop new systems that ensure all patients diagnosed with TB are subsequently enrolled in treatment. Our analysis suggests that currently this linkage rate is only 75-80%, and we would like to see this increase to 100%.

Finally, with Xpert we now have the ability to diagnose patients with presumed MDR-TB. Identifying and appropriately treating these patients early is critical to stopping the increasing rates of drug resistant TB. We are working closely with the Mozambican TB program to optimally care for these patients.

We are encouraged by the changes we have seen in the last year, and we look forward to continuing to support the Mozambican TB program in their effort to provide the best care possible to patients with TB.

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