The sample collection method is still troublesome especially in children clients and worst when collected by Non medical Personnel or untrained personnel.
Often only few positives for drug resistance are seen.,
how do we get to know the impact of Gene-expert for TB management in DOT centre,
a colleague could be useful since this is his area of expertise. Dr Moses Jolaba, get him on [email protected]
Regarding sputum sample collection, it is true that this is a challenge but it is limited to children below the age of 6 years; most children after this age can be instructed to expectorate and produce sputum reliably.
For kids under 6 years obtaining specimen is possible where there are appropriately skilled personnel that could perform gastric washings after overnight fasting. This may require admission in a facility, but it may still be feasible in the DOTS centres with skilled staff (who can perform the procedure) - caregivers could be instructed to withhold oral administration of food/drinks overnight and present the child to the DOTS facility in the morning to perform the procedure.
These considerations only apply where pulmonary TB is being suspected. The challenges of lack of specimen in extra-pulmonary TB applies equally across children and adult patients. These scenarios should be referred to hospitals with experts capable of obtaining specimen from the appropriate site (e.g. lymph node aspiration/biopsy, CSF, pleural or ascitic aspirates, etc.).
The only way to guarantee quality of samples collected is to train and constantly supervise personnel charged with the responsibility of sample collection.
It is in order if “Only few positives for drug resistance are seen” as you stated. This is because drug resistant TB is much less common and drug sensitive TB organisms still prevail in all settings, even though the prevalence of DR-TB is higher in some places than others.
A good way to assess the impact of GeneXpert in the management of TB in any setting is to document numbers of cases identified over the period (e.g. 6-12 months) after inception of use of GeneXpert and those patients placed on treatment and compare with corresponding figures before the introduction of the technology. Other ways include comparing the average time taken to confirm TB diagnosis with GeneXpert (from presentation at the facility) and commence treatment compared to time taken with other diagnostic methods (sputum microscopy).
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