James Milburn, Ookeditse Ntwayagae, Kebatshabile Ngoni, Rachita Suresh, Neo Lemme, Cassie Northcott, James Penney, Matthew Kinsella, Imogen Mechie, Samuel Ensor, Tony Chebani, Daniel Grint, Mark W Tenforde, Ava Avalos, Dinah Ramaabya, Ronan Doyle, Margaret Mokomane, Madisa Mine, Katharina Kranzer, Joseph N Jarvis
{"title":"The impact of GeneXpert cerebrospinal fluid testing on tuberculous meningitis diagnosis in routine care in Botswana","authors":"James Milburn, Ookeditse Ntwayagae, Kebatshabile Ngoni, Rachita Suresh, Neo Lemme, Cassie Northcott, James Penney, Matthew Kinsella, Imogen Mechie, Samuel Ensor, Tony Chebani, Daniel Grint, Mark W Tenforde, Ava Avalos, Dinah Ramaabya, Ronan Doyle, Margaret Mokomane, Madisa Mine, Katharina Kranzer, Joseph N Jarvis","doi":"10.1093/ofid/ofae489","DOIUrl":null,"url":null,"abstract":"Introduction Tuberculous meningitis (TBM) disproportionately impacts high-HIV prevalence, resource-limited settings where diagnosis is challenging. The GeneXpert platform has utility in TBM diagnosis but uptake remains limited. In Botswana, prior to the introduction of GeneXpert, TB testing was only available through mycobacterial culture at the National TB Reference Laboratory. Data describing routine use of Xpert MTB/RIF for CSF testing in resource-limited settings are scarce. Methods Electronic records for patients with CSF tested in government facilities in Botswana between 2016-2022 were obtained from a central online repository as part of ongoing national meningitis surveillance. Samples were excluded from one site where Xpert MTB/RIF is performed universally. The proportion receiving TB-specific investigation on CSF and the number positive for Mycobacterium tuberculosis following increased Xpert MTB/RIF capacity were determined. Results The proportion of CSF samples receiving TB-specific investigation increased from 4.5% (58/1288) in 2016 to 29.0% (201/693) in 2022, primarily due to increased analysis with Xpert MTB/RIF from 0.9% (11/1288) to 23.2% (161/693). There was an overall decline in the annual number of CSF samples analysed but the proportion with microbiologically-confirmed TBM increased from 0.4% to 1.2%. The proportion of samples tested for TB that were collected from healthcare facilities >100km from the National TB Reference Laboratory increased with Xpert MTB/RIF rollout from 65.9% (87/132) to 78.0% (494/633). Discussion In Botswana access to TB culture is challenging in remote populations; more accessible near-patient testing using Xpert MTB/RIF increased the number of patients receiving TB-specific testing on CSF and the number of confirmed TBM cases.","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofae489","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction Tuberculous meningitis (TBM) disproportionately impacts high-HIV prevalence, resource-limited settings where diagnosis is challenging. The GeneXpert platform has utility in TBM diagnosis but uptake remains limited. In Botswana, prior to the introduction of GeneXpert, TB testing was only available through mycobacterial culture at the National TB Reference Laboratory. Data describing routine use of Xpert MTB/RIF for CSF testing in resource-limited settings are scarce. Methods Electronic records for patients with CSF tested in government facilities in Botswana between 2016-2022 were obtained from a central online repository as part of ongoing national meningitis surveillance. Samples were excluded from one site where Xpert MTB/RIF is performed universally. The proportion receiving TB-specific investigation on CSF and the number positive for Mycobacterium tuberculosis following increased Xpert MTB/RIF capacity were determined. Results The proportion of CSF samples receiving TB-specific investigation increased from 4.5% (58/1288) in 2016 to 29.0% (201/693) in 2022, primarily due to increased analysis with Xpert MTB/RIF from 0.9% (11/1288) to 23.2% (161/693). There was an overall decline in the annual number of CSF samples analysed but the proportion with microbiologically-confirmed TBM increased from 0.4% to 1.2%. The proportion of samples tested for TB that were collected from healthcare facilities >100km from the National TB Reference Laboratory increased with Xpert MTB/RIF rollout from 65.9% (87/132) to 78.0% (494/633). Discussion In Botswana access to TB culture is challenging in remote populations; more accessible near-patient testing using Xpert MTB/RIF increased the number of patients receiving TB-specific testing on CSF and the number of confirmed TBM cases.
期刊介绍:
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.