High-tech TB machines underutilised- report

According to the health ministry, it needed at least Shs10b to treat the increasing cases of the deadly multi-drug resistant TB annually.

Last month, the ministry reported that 134 GeneXpert machines had been installed, covering 124 health facilities in 97 districts.

By last month, the Global Fund funded the procurement of 113 GeneXpert machines, 13 of which had been installed.

The World Health Organisation (WHO) approved rapid diagnostic tests, such as Xpert to speed up the diagnosis and treatment of TB.

However, despite having the highest coverage of 93 per cent of Xpert machines in East Africa, Uganda’s usage of rapid diagnostics to test TB stands at 24 percent, according to a survey by who whose findings were released last week in Kampala.

According to the study, which was carried out by a consortium of scientists under a project known as Tuberculosis: Working to Empower the Nation’s Diagnostic Effort (Twende), the coverage and use of MTDRplus, the only rapid test that confirms multi-drug resistance, is at less than 1 per cent in the country.

Giving the outcomes of the survey, that were released at Hotel Africana, the project coordinator Ivan Mwebaza, said the interviewed 86 District Health Officers (DHO), on the state of TB diagnosis and treatment and the presence of GeneXpert machines in their districts, in addition to their knowledge about LPA.

The LPA is a rapid test that tells whether a patient has multi-drug resistant TB.

To verify DHO’s response, 52 healthcare centres were audited for the coverage and utilisation of the same tests, 40 (77 percent) had the GeneXpert machine, but only 12 (23 percent) utilized the machine to full capacity, that is, performed eight TB tests per day (160 tests per month).

According to findings of the survey, there is good coverage of the Xpert machines at 72 per cent but they are grossly underutilized.

Out of the 86 districts surveyed, 62 (72 percent) of the DHOs reported having GeneXpert machines in their district, while 24 (28 percent) reported no       GeneXpert in their district.

Mr Mwebaza said for the districts that did not have GeneXpert machine, the DHOs said the main reason was underfunding. None of the 86 districts surveyed had LPA test, and this is because most of the DHOs 52 (61 percent) did not know what the test is.

Interestingly, majority 11 (92 percent) of the healthcare care facilities that utilised the GeneXpert machine to full capacity were regional referral hospitals and not the peripheral district hospitals. This means that full usage of GeneXpert is limited to regional hospitals and yet WHO approved their usage starting from district hospital level.

“The near 0 percent coverage of the LPA test, coupled with limited use of tuberculosis culture, means that the ability of Uganda to detect multi-drug resistant TB is very low,” Mr Mwebaza said.

“With limited use of the machine and LPA test, it means there is under reporting of TB cases in the country which makes it difficult to eliminate the disease.”

TB is the ninth leading cause of death worldwide. In Uganda, TB treatment coverage is at 52 per cent and out of the 29 per cent of the TB control budget fund, only 3 per cent comes from domestic sources.

TB prevalence in the country stands at 253 per 100,000. Uganda records 87,000 new TB cases every year. The survey also shows that stigma from both clinicians and the community is still very high, thus contributing to low case detection.

“Most people think that whoever has TB has HIV/AIDS but that is not true. 60 percent of TB patients are not HIV positive. Let us not stigmatize people  with TB. This will enable them seek treatment effectively and recover completely,” Dr Wilber Sabiiti, the principal Investigator and leader of the Twende Consortium, said.

Recommendations such as establishing refresher training programmes to update and diversify skills of practitioners, innovative approach of domestic fundraising to expand budget allocation to healthcare and research were made to improve diagnosis and treatment of TB in the country.