PEPFAR adds to investment in rapid TB tests

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Cepheid's single-module GeneXpert MTB-RIF rapid tuberculosis diagnostic.

The President’s Emergency Plan For AIDS Relief will buy as many as an additional 150 rapid tuberculosis testing devices with materials to test about 450,000 people for tuberculosis, addressing a need to improve diagnoses of drug-resistant strains of disease, and to identify the disease in HIV-positive people in sub Saharan Africa and Myanmar, the Office of the Global AIDS Coordinator announced today.

The announcement of the program’s added investment in the Cepheid Xpert tests, following the pre-World AIDS Day release last week of PEPFAR’s Blueprint for creating an AIDS-free generation backs the plan’s stated purpose of applying evidence-based approaches and scientific advances to confront the global HIV epidemic.

The investment is part of an ongoing effort, though, with the funds coming from $160 million the office announced in April 2011 to target HIV/TB coinfection. The expenditure was delayed to take advantage of anticipated price drops, according to an OGAC representative. In August, PEPFAR, USAID, UNITAID and the Bill and Melinda Gates Foundation announced a coordinated effort that had lowered the cost of the cartridges required for each test from $16.86 to $9.98. The device itself can cost $17,500 or more, depending on model.

Tuberculosis is the leading killer of HIV-positive people in Africa, but is difficult to diagnose in people with immune systems damaged by the virus. Most developing countries rely on detecting the disease through microscopic analysis, missing as many as 80 percent of cases among people with HIV, and about half of all tuberculosis cases. The Xpert test is estimated to increase identification of drug resistance at least three-fold. Last year nearly nine million people became sick with active tuberculosis, and about one and a half million people died of the disease.

Wider availability of the test, which delivers results in less than two hours, can detect resistance to the first-line medicine used to treat tuberculosis, and is more sensitive than the older method, is considered vital to saving lives of people with HIV, and slowing the spread of drug-resistant strains. Older tests can take as long as three months to deliver results in resource-poor settings. And while the initial outlay for Xpert devices, and the cost of cartridges used for each test are much more expensive than the old technology, the older tests carried additional costs in staffing, infection control requirements, as well as the costs of delayed and ineffective treatment.

The $11 million PEPFAR will spend on the effort also will support health worker training and integration of the testing into national health systems in the countries where the tests will be used.

Countries receiving the rapid tests

For updated information on where Xpert testing is used, the World Health Organization maintains a database by country, to date.

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