GeneXpert’s Speedy Diagnosis gets Patients onto TB Treatment Quicker

In the rural setting of the South African province of KwaZulu-Natal (KZN), where extreme weather and mountainous terrain can often make roads impassable, the journey to a TB diagnosis can be long and difficult. But the placement of a cutting-edge diagnostic machine in a rural clinic thanks to support from PEPFAR through the Centers for Disease Control and Prevention (CDC) has meant that TB/HIV Care Association has dramatically shortened the time and ease with which TB patients can be found and started on treatment.

Pholela Community Health Centre is located in a village, more than two-hour drive from the nearest laboratory. This means that getting the results from a sputum sample sent for TB diagnosis at the laboratory takes a long time, often up to six weeks. To diagnose drug-resistant TB takes even longer - up to eight weeks for TB culture and susceptibility results. The province is the epicentre of South Africa’s HIV epidemic, with high levels of TB infection. In KZN, the level of drug resistant TB is high, with 8% of all TB cases being resistant to first-line drugs. The high levels of HIV – with a prevalence of 23% -- makes people more vulnerable to opportunistic infections like TB. Rapid diagnosis of TB and of drug resistance and starting patients on effective treatment quickly is critical to the health of each individual, and also the health of the entire community.

With funding from PEPFAR through CDC TB/HIV Care Association placed a GeneXpert machine that can diagnose TB and drug-resistant TB in less than two hours in the heart of the province, in the Pholela community health Center.

TB/HIV Care's community health workers support the project by creating links in the chain of care between the patient, clinic, and lab. The community health workers go out into the community to screen people for symptoms of TB. When they find someone with TB symptoms, they urge the person to go to the clinic for a TB test, and failing this, they take a sputum sample and deliver it to the clinic themselves. Once the GeneXpert has performed the TB test, the community care worker can follow up with the patient to ensure that they are started on treatment if necessary.

This chain of care and speedy delivery of test results means that the period of time between when a patient with symptoms is found to when they are started on treatment for TB has been significantly reduced. Previously, 90% of patients at Pholela CHC took more than five days to be put on treatment after arriving at the clinic. Now, 89% of patients are put on treatment within five days of their symptoms having been detected. In the last three months at this clinic in 2012 78% of patients have been started on treatment within two days of diagnosis.

The innovative diagnostics of GeneXpert partnered with the huge human investment and caring provided by community health workers makes this TB/HIV Care Association project a huge success more patients can be put on TB treatment and cured, and in turn fewer people in the community will be infected with TB.