Traditionally, tuberculosis is mostly being diagnosed by a combination of chest X-rays, the staining of sputum with special dyes followed by microscopy, the growth of Mycobacterium tuberculosis in culture and the Mantoux test. The sputum smear microscopy is easy to do and is very cheap and combined with chest X-rays has been used for a long time by TB control agencies worldwide. However the sputum smear microscopy (sputum AFB ) test has some problems in HIV-positive patients and children also in patients with low bacterial load.
There is however a modern method, the geneXpert MTB/RIF test exhibits high sensitivity and specificity for detecting pulmonary TB disease. The geneXpert MTB/RIF assay is a new test that is revolutionizing tuberculosis (TB) control by contributing to the rapid diagnosis of TB disease and drug resistance. The test simultaneously detects Mycobacterium tuberculosis complex (MTBC) and resistance to rifampin (RIF) in less than 2 hours. In comparison, standard cultures can take 2 to 6 weeks for MTBC to grow and conventional drug resistance tests can add 3 more weeks. The information provided by the geneXpert MTB/RIF assay aids in selecting treatment regimens and reaching infection control decisions quickly.
Among the successes of the geneXpert technology is increased network of equipment. Also there has been increased uptake of Genexpert with utilization up from 15% quarter 4, 2014 to 55% quarter 4, 2015. There has been increased effort to strengthen counties to implement geneXpert. As a result, many more cases have been diagnosed, 15,000 in 2015 with 400 showing they could be resistant to first line and there has been reduced turnaround time for TB diagnosis and rifampicin resistance surveillance to 24hrs down from close to two months for a phenotipic/culture testing
Important interventions being undertaken to make geneXpert a success include supporting sites with internet connectivity to support case based data management, supporting counties to further increase utilization to the set target of 80% by targeting sensitization of a larger group of healthcare workers/prescribers, strengthening Sample transport mechanisms and strengthening commodity management at county level. Also, plans are underway to start using GeneXpert as first test in facilities where it is available and support for hardware (costs for replacement of parts and routine scheduled servicing)
According to Jeremiah Okari who is the geneXpert coordinator, there are currently 70 GeneXpert Machines installed in Kenya today. He further affirms that with the installation, validation and training on the use of the machines, Kenya can now guarantee quick and effective TB diagnosis particularly among the vulnerable groups of children, MDR clients and People Living with HIV among others.