While our laboratory results are encouraging, initial performance analysis suggest that only 65-80% of patients with positive pulmonary TB test results that do not have rifampin resistance are being linked to treatment. Our preliminary data also suggests that only 34% of patients diagnosed with TB and rifampin resistance are being appropriately started on empiric MDR-TB therapy, have sputum samples sent for culture, and are then tested and treated for HIV. Recent studies highlight the importance of treating newly diagnosed co-infected patients first for TB, and then starting combination anti-retroviral therapy (ART) within 2-8 weeks. Delaying treatment with ART beyond this time period leads to increased mortality and morbidity. This project has two aims; a formative research component and an evaluation component.
This is a two-year, interdisciplinary research project to explore the HIV/TB/MDR-TB care cascade (the process by which Mozambican patients are screened for TB/MDR-TB and HIV, tested for these diseases, linked to care, started on treatment, and followed through treatment to determine treatment outcomes) in central Mozambique and to evaluate an innovative mHealth platform to improve treatment initiation rates called GxAlert. GxAlert allows remote Xpert sites to upload positive test results to a secure central database, and positive tests for TB and rifampin resistance trigger automatic SMS messages to key TB program personnel in an effort to ensure that these patients are rapidly enrolled in appropriate therapy. Untreated individuals continue to spread TB in their communities. The first part of this study is qualitative, and involves flow mapping the TB/HIV/MDR-TB care cascade at 5 TB facilities in Sofala and Manica, and holding focus groups and individual interviews with patients and care providers to better understand the current system. The second part of this study is quantitative, and will evaluate the TB treatment initiation rates of patients with a positive Xpert test before and after the implementation of GxAlert.
We are also working with the national and provincial TB heads and their teams to make changes in order to ensure all patients with a positive test are started on treatment, particularly those with MDR-TB. Together with the MOH, we are conducting a cost analysis study to determine how best to expand these new technologies in the provinces of Manica and Sofala, as well as throughout Mozambique. While these new diagnostic platforms are an important step forward, they are also more expensive, and can be challenging to maintain. At HAI we are seeing increasing interest in improving the entire TB treatment cascade (from screening and diagnosis to treatment) both within Mozambique and the global health community and we look forward to continuing to support this effort in the years ahead.
This grant is supported by the University of Washington Center for Aids Research.