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Commentary by Dr Tim France, global health

commentator & Managing Director, Inis Communication


Ending tuberculosis (TB) is possible only when we diagnose TB early; characterize the nature and in
particular the drug-sensitivity of each case; then treat the person with drugs that are most likely to
work; we also have to help support patient adherence; and address other issues as per the WHO End TB
Strategy.
The study we are looking at today, published a month ago, assessed the impact of up-front Xpert
testing on detection of pulmonary tuberculosis and rifampicin-resistant pulmonary TB cases in India.
Before we get started, lets unpack some of the terms and ideas the study explored:
What is up front Xpert MTB/RIF testing? Essentially using state-of-the-art molecular test for diagnosing
TB and at the same time as assessing resistance to at least one of the main drugs used to treat the
disease.
The Xpert MTB/RIF test is a relatively new diagnostic test that confirms whether a suspected TB case
really is TB, and also whether the individual case of TB is likely to respond to the most commonly used
drugs. If a patient is believed to have drug-resistant TB, then it is important to switch their treatment to
drugs that their TB is sensitive to. Treating with drugs that do not work is dangerous for the individual
patient, but also for broader public health as it may increase drug resistance.
This is a critical part of implementing and achieving the WHO End TB Strategy.
Before the introduction of tests such as Xpert, the time delay between detecting TB and understanding
drug sensitivity was considerable. One study published in 2014 found that, in India, on average TB
patients have to wait for about two months before a TB diagnosis is made and they have to see at least
three different doctors before a doctor tests the person for TB, and then starts the anti-TB therapy [in
India]
In India, patients often have to take six months of standard anti-TB therapy before DST is performed.
Most patients never know if they have drug resistance early on - they only get to know when they fail
one round of anti-TB therapy, or have recurrence.
Xpert offers the opportunity of conducting both tests at the same time, at the point of care.
The current study showed two important results: When implemented on a large scale in India the Xpert
test significantly increased case-notification rates of all bacteriologically confirmed TB cases (39%) and
increased rifampicin-resistant TB case detection by over fivefold compared to conventional drug
sensitivity testing.

Until a month ago, we did not have this evidence base of just how beneficial it could be to detect drug
resistance at the time of TB diagnosis. Over 100,000 patients... The study results provide a solid
rationale/ evidence on how important it could be for progressing towards ending TB.
The webinar today, we will provide you an opportunity to interact with the study author(s), lead TB
experts from the World Health Organization and the International Union Against Tuberculosis and Lung
Disease (The Union) to learn about the study findings and ask questions from the experts.
We have already received some questions from journalists in Myanmar, Pakistan, Nepal and as far
afield as Swaziland.