Introduce new and rapid technologies and laboratory service to accelerate access to multi-drug resistant MDR-TB diagnosis in low-income settings
Diagnosing MDR-TB is extremely difficult in resource-poor settings, where access to laboratories with sophisticated equipment can be limited. In the best scenario, countries with high to moderate burden of TB or MDR-TB will have a fully-functioning laboratory capable of performing TB culture and drug-susceptibility testing (DST) for every 2 to 10 million in population. But in reality, most countries have little or no diagnostic capacity for MDR-TB.
Instead, many countries rely on more traditional testing methods for MDR-TB. These typically take up to four months for results to be ready. Since MDR-TB requires specialized treatment to fight the resistant bacilli, a lack of diagnostics for drug-resistance can prove deadly. In 2008, prior to the EXPANDx TB project initiation, the 27 EXPAND-TB supported countries had reported to the WHO close to 10,000 MDR-TB cases, which reflect the extremely difficult scenario on diagnostics capability in these countries.
UNITAID and its implementers have reduced the diagnostic gap by bringing state-of-the-art and quality-assured technologies and laboratory services to countries most afflicted by tuberculosis. Through EXPANDx TB, twenty seven low-income and high-burden TB countries now have fully functioning laboratories, equipped with a number of new diagnostic tests, including the “line probe assay” and Xpert MTB Rif. These advanced tests can detect MDR-TB within two days so patients can start effective treatment. By 2012 the number of MDR-TB cases being notified in the same countries had tripled to over 35,000 cases, as compared to MDR-TB case detection in 2008.
Between 2009 and 2012 over 90,000 MDR-TB cases were reported to WHO by national TB control programs of the 27 countries where EXPAND-TB has been implemented; over 36,000 of those cases were diagnosed with EXPAND-TB project support. In 2009 alone, the contribution of the EXPAND-TB project to MDR-TB case finding was 14% of the cases diagnosed in the 27 countries and by 2012 the figure had reached 69%.
EXPANDx has also achieved price reductions of up to 80% for sophisticated diagnostic equipment and supplies through special negotiations and via competitive tenders. New laboratory infrastructure and successful technology transfer has been established in the 27 project countries. This effort was accompanied by training to integrate these technologies within national TB control programmes and improve MDR-TB case detection and technical capacity building to incorporate these technologies into programmatic settings.
Cumulatively about 106,983 MDR-TB cases have been detected till end-2014 under this project. A hundred and one of the planned 103 state of the art Central or Reference laboratories have been established under EXPAND TB. Over 710,270 line probe assyas, 929,163 tests using liquid culture, 165,849 liquid culture tests for drug susceptibility testing and 215,850 Xpert MTB/Rif tests were procured to EXPAND TB countries since the start of the project. In over 340 training sessions in the 27 countries, more than 3000 staff have been trained on the new laboratory technologies.
The EXPAND TB Project countries are: Azerbaijan, Bangladesh, Belarus, Cameroon, Cote d’Ivoire, Djibouti, Ethiopia, Georgia, Haiti, India, Indonesia, Kazakhstan, Kenya, Kyrgyz republic, Lesotho, Mozambique, Myanmar, Peru, Republic of Moldova, Rwanda, Senegal, Swaziland, Tajikistan, Uganda, UR Tanzania, Uzbekistan, Viet Nam. Currently this Project is transitioning: 13 countries have transitioned out at the end of 2014 and the remaining 14 countries will transition out at the end of 2015.