KADOMA — IT is early in the morning at an Integrated Tuberculosis HIV Centre (ITHC) in Rimuka township. Men and women sit on opaque-coloured timber benches, talking animatedly.
BY STEPHEN TSOROTI
While the majority are from Rimuka, several others have come from other places around Kadoma to be tested for tuberculosis (TB) and for treatment reviews. Two hours later, the place is almost deserted.
The nurse-in-charge at the centre, Gift Scholtz, quickly explains that the acquisition of the Gene-Xpert machine to detect TB has contributed to the development.
“The centre has acquired state-of-the-art equipment to detect TB which has lessened time for consultation and diagnosis,” he says.
He further explains that Rimuka ITHC is one of many centres in Zimbabwe that are now using the Gene-Xpert, a fast and novel technology to diagnose TB, including the most difficult to diagnose, Drug Resistant TB (DR-TB).
“Decades ago in the hospital I used to work, TB was primarily diagnosed through X-ray screening and clinical examination, but it fell short of carrying out specific indicators of TB infection,” Scholtz says.
The Gene-Xpert is a small machine, about the size of a microwave oven. It can detect mycobacterium tuberculosis in a sample of sputum. A person presumed of having TB needs to give a sputum sample, which the healthcare worker then places in a small tube.
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From the tube, the sample is fed into the machine, and then biochemical reactions are started to see if the sample contains the TB bacterium. The machine looks for the DNA specific to the TB bacterium. It can also detect the genetic mutations associated with resistance to the drug Rifampicin.
The main advantages of the test are, for diagnosis, reliability when compared to sputum microscopy and the speed of getting the result when compared with former methods.
To date, the country has relied much on the smear microscopy method with 225 laboratories scattered around the country. In existence since 1800s, sputum microscope works by using a microscope to look for TB bacterium in a patient’s sputum. While preferable to X-ray screening as a primary screening method, sputum microscopy requires trained laboratory staff and proper guidelines and takes days to produce results This simple method also does not identify drug resistant strains of TB. For that the patient’s sputum must be further tested, which can take months.
International Union against Tuberculosis and Lung Disease (The Union) Zimbabwe country director Christopher Zishiri explains that the Gene-Xpert machine increases the chances of identifying or diagnosing TB in patients like those with TB-HIV co-infection, younger children, and those not producing enough sputum for use with other test methods such as microscopy.
He adds that, on the other hand, patients with TB that has not yet caused enough lung damage can be picked up by X-rays.
Having this kind of technology has several benefits explains Julie Nenon, USaid/Zimbabwe acting mission director.
“For patients who test negative, the speed of the diagnosis means medical professionals can rule out TB early on and move quickly to correctly diagnose the patient, allowing for earlier treatment for the correct disease. For those with TB, a quicker diagnosis means they are put on TB medicines earlier, reducing the chances of spreading the disease and improving the chances of being cured. In addition, patients with drug resistant TB [which is more expensive and takes longer to treat] also benefit since delays in treatment may accelerate the loss of lives,” she says.
USaid is working in collaboration with the Ministry of Health and Child Care’s National Tuberculosis Programme to make the technology readily available to all TB patients at all times through procuring Gene-Xpert machines for health facility laboratories in Zimbabwe.
Zimbabwe is one of the eight countries in Africa belonging to all the top 30 high burden lists of TB, TB/HIV, and DR-TB in the world.
According to Charles Sandy, director of the TB Unit in the Ministry of Health And Child Care (MoHCC), HIV is driving TB and there is high rate of co-infection.
“The need for new technology for diagnosis cannot be over-emphasised,” Sandy says.
The number of People Living with HIV (PLHIV) in the country is estimated to be 1,4 million, according to the Zimbabwe Demographic Health Survey of 2011.
To date, USaid has procured 41 machines for several health facility laboratories in the country, which will increase the speed and accuracy of TB diagnosis, particularly drug-resistant TB. USaid has also provided technical support for the procurement, installation, monitoring, and maintenance for over 121 Gene-Xpert machines in the country.
USaid directly procured 41 machines and also provides support for the installation and use of the equipment.
Training health care workers to properly use the equipment. Monitoring the performance of the equipment installed at TB diagnostic sites.
“We could not have identified this growing trend of TB strain if was not through the aid of the new diagnosis tool we are using now,” Scholtz recalls.
He says locals are pleased with the proximity of the site reducing the distances to the tests sites and the sometimes uneasy struggle to get transport to the nearest health centre.
