The Sunday Mail
In Zimbabwe, tuberculosis has traditionally been detected by searching for evidence of TB bacteria through sputum smear microscopy.
One spits a phlegm (makararwa) and the sample is then examined under a microscope.
However, the World Health Organisation (WHO) now recommends the use of a Gene Xpert machine which is more sensitive in detecting Drug Resistant TB (DR-TB).
The introduction of the Gene Xpert machines in Zimbabwe is a positive step towards TB interventions.
According to the Ministry of Health and Child Care deputy director (HIV and TB unit), Dr Charles Sandy, the machines have reduced the long period in which DR-TB samples would take to produce results.
“The coming in of Gene Xpert machines in Zimbabwe has reduced the time we used to take to diagnosis DR-TB from 12 weeks to just a day,” said Dr Sandy.
“This means DR-TB patients are being put on second-line treatment earlier and the capacity to diagnose DR-TB has improved tremendously.”
He said the Gene Xpert machines have brought about early and more effective detection of TB.
The advanced TB-detecting machine can also be used to check the viral load of people living with HIV.
Dr Sandy acknowledged that the Gene Xpert machine has more credit in diagnosis and interventions in TB treatment because of its sensitivity.
“A Gene Xpert machine is a more sensitive and specific diagnostic tool for TB. Therefore, it minimises false TB diagnosis when compared to the traditional method. When using Gene Xpert, the test is easier to perform and results are out in two hours therefore it means same-day diagnosis and treatment initiation is possible, thereby minimising the back-and-forth movement of patients to the health facility,” he said.
However, while Gene Xpert machines have more credits than the traditional smear microscopy, using the machines is costly.
Dr Sandy also revealed that smear microscopy is vital for treatment follow up.
“Smear microscopy will remain relevant until we have adequate resources to procure adequate cartridges (for the Gene Xpert machines). This change will require an investment of about $5 million annually for cartridges alone,” said Dr Sandy.
In a separate interview, The Union (TB Challenge) country director, Dr Christopher Zishiri, said the microscopy machine in TB diagnosis is still relevant even if the country has moved to the Gene Xpert era.
“Microscopy is still necessary for detecting TB for first-line treatment, and Gene Xpert machines are affordable to run. Our country cannot phase out the microscopy for Gene Xpert because the cartridges for Gene Xpert machines are quite expensive,” said Dr Zishiri.
“On the other hand, the microscopy is easier and cheaper to operate even though they cannot detect DR-TB.”
The Union is working in partnership with the Health Ministry in ensuring that cartridges for Gene Xpert machines are available countrywide.
Zimbabwe has a total of 120 Gene Xpert machines which are evenly distributed nationally.
Information from the ministry shows that of the total figure; 42 came from Global Fund, 12 from National Aids Council, 10 from USAid/PEPFAR, 26 from The Union, 12 from MSF, four from IOM, one from Solidamed, eight from the TB Research Project, four from PSI and one from Beat Aid Zimbabwe.
“Bulawayo has four Gene Xpert machines, Harare has four, Chitungwiza has three, Manicaland 14, Mashonaland Central 12, Mashonaland East 13, Mashonaland West 11, Masvingo 12, Matabeleland North 11, Matabeleland South 12 and Midlands 12,” reads a statement from the Health Ministry in part.
While the Gene Xpert machines are distributed countrywide, there are some health sites which are still lacking resources for TB diagnosis, such that they post TB specimen to other sites for diagnosis.
Recently, The Sunday Mail Extra visited Dombotombo Council Clinic in Marondera. The clinic is still posting TB specimen to its provincial hospital.
The council clinic was renovated by The Union to accommodate a laboratory for TB diagnosis. However, the lab is still idle because there are no microscopic experts to detect TB.
“Although we have a laboratory for TB specimen and diagnosis, at the moment we do not have laboratory personnel and a microscope machine for TB diagnosis,” said the sister-in-charge, Everett Botshiwe Pasipamire.
“The TB specimen are being ferried by an ambulance to our provincial hospital and results are collected after three days.
“This is a challenge because the clinic has only one ambulance. On the other hand, the specimen cannot be ferried in public transport.”
“Waiting for three days for the results is a challenge on its own because some of our patients may not come back for the results, so we end up doing follow-ups in their homes, which is costly but at the same time essential because people should know their TB status and be initiated on treatment early.”