TY - JOUR T1 - GeneXpert for TB diagnosis: planned and purposeful implementation JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 18 LP - 23 DO - 10.9745/GHSP-D-12-00004 VL - 1 IS - 1 AU - Amy S Piatek AU - Maarten Van Cleeff AU - Heather Alexander AU - William L Coggin AU - Manuela Rehr AU - Sanne Van Kampen AU - Thomas M Shinnick AU - YaDiul Mukadi Y1 - 2013/03/01 UR - http://www.ghspjournal.org/content/1/1/18.abstract N2 - Xpert MTB/RIF is a major advance for TB diagnostics, especially for multidrug-resistant (MDR) TB and HIV-associated TB. But implementation concerns including cost, technical support requirements, and challenging demands of providing second-line TB drugs for diagnosed MDR-TB cases call for gradual, careful introduction based on country circumstances. Tuberculosis (TB) continues to be one of the greatest killers in the world due to infectious disease, claiming over 1.4 million deaths in 2011.1 In recent years, the prevention, diagnosis, and treatment of TB has become more complicated because of 2 factors changing the epidemic: HIV-associated TB and multidrug-resistant (MDR) TB. Many people die from TB because their diagnosis is delayed, and the epidemic continues to endure because we are unable to significantly reduce transmission with current diagnostics. Xpert MTB/RIF® (or Xpert), based on the GeneXpert platform, offers a major breakthrough against these limitations—but only if it is implemented within a context of strong national program and laboratory strategic plans and according to a comprehensive technical approach that includes everything from planning to evaluation. Sputum smear microscopy remains the most common way to diagnose pulmonary TB. Depending on the report and method used, smear microscopy can accurately detect TB in 20% to 80% (using fluorescence microscopy methods) of TB cases.2 Sputum smear microscopy has significant limitations because it can only be used to diagnose TB when sputum has sufficient bacillary load, and it cannot detect drug resistance. Thus, HIV-associated TB often goes undetected because people living with HIV (PLHIV), especially those with severe immunosuppression, generally have very low numbers of bacilli.3 A more sensitive approach to diagnosis is to culture sputum samples, which can include testing for drug resistance. However, such techniques require expensive and sophisticated laboratory infrastructure and staff, and it can take weeks or months to obtain results. Realistically, … ER -