Multi-drug resistant (MDR) and extensively drug resistant (XDR) tuberculosis arise in patients experiencing improper treatment regimens, and reveal weaknesses in health delivery systems both for diagnosis and treatment for tuberculosis. Fewer than 20% of MDR/XDR-TB cases have access to valuable diagnosis and treatment options (International Journal of Tuberculosis and Lung Disease, December 2012).
A new rapid diagnostic tool for detecting rifampicin resistance was endorsed by the World Health Organization in December 2010. The endorsement of GeneXpert MTB/RIF provided global sites with a way to detect markers for drug-resistant TB, and promised to be a game-changer to the diagnosis of drug-resistant TB. Three years later, the cost of GeneXpert cartridges have been reduced by 40% and PEPFAR and UNITAID both created projects to increase uptake and utilization of the test in high-burden countries and by public sector entities in 145 eligible countries. (World Health Organization, 2013)
The rapid roll-out and scale-up in countries with very different epidemiology and health systems has generated an immense need for timely technical guidance and collaboration. Under the guidance of Christopher Gilpin, PhD, MPH, GHDonline moderator and scientist in TB Diagnostics and Laboratory Strengthening Unit of the Stop TB Department at the WHO, and a member of the team leading the global roll-out and scale-up of the GeneXpert MTB/RIF assay, GHDonline is the host of a series of virtual expert panels and discussions to improve the uptake and usage of GeneXpert MTB/RIF worldwide and especially in countries with limited resources. This brief summarizes lessons learned from our second panel hosted in December 2012.
Discussion was dominated by an ethical dilemma: should the use of GeneXpert MTB/RIF be extended to locations without access to proper treatment drugs? Experiences and anecdotes from panelists and members in the Democratic Republic of the Congo, Belgium, Cambodia, Ethiopia, Kinshasa, and South Africa, as well as from Cepheid, the manufacturer, can be found in this expert panel.