GeneXpert Expansion for APOPO TB Mozambique

By Dr. Emilio Valverde | Country Program Manager, APOPO TB Mozambique

APOPO TB Mozambique responds to the national rollout of GeneXpert technology.

Last year the Stop TB Partnership and the Global Fund joined forces to contribute towards finding and treating an additional 1.5 million people with tuberculosis who are currently missed by health systems in 13 high TB-burden countries including Mozambique. Till now the APOPO TB program has been maintaining full coverage of all microscopy TB suspect samples produced in the city of Maputo. However, in 2017 Mozambican health authorities started a roll out of the GeneXpert technology with the TB test Xpert MTB/RIF which is far more accurate than standard microscopy and catches many more TB-positive patients at clinic. This substitution of microscopy by Xpert resulted in a lower number of samples received by APOPO allowing APOPO to adjust its strategy to increase Xpert testing at its TB facility in Maputo in partnership with Medecins Sans Frontieres (MSF) who operate in Maputo under the directorate of MSF Switzerland. This will firstly allow APOPO to take on overlap from clinics that are unable to test the high number of patients that present at clinic, simply due to time constraints. Incorporating Xpert will also allow APOPO TB Mozambique to launch a study comparing the TB detection rats to Xpert. Although Xpert testing is already included in APOPO’s TB strategy, until now the number of samples passed through has not been conducive to a study of this kind.

GeneXpert technology was endorsed by the World Health Organization (WHO) in 2010. It involves a molecular TB test detecting the DNA in TB bacteria, also being able to indicate if a patient may have multidrug-resistant TB. The WHO recommended that Xpert MTB/RIF be used as the initial diagnostic test in patients suspected of multidrug-resistant TB or HIV-associated TB. The global rollout of GeneXpert machines started soon after. The WHO did also emphasize that conventional microscopy culture and drug sensitivity testing are still needed, as these are required to monitor treatment progress and to detect other types of drug resistance in the clinics. The GeneXpert MTB/RIF cannot be used for treatment monitoring, as it detects both live and dead bacteria.

APOPO in Mozambique is currently finishing off an expansion of the project facilities at the Veterinary School of the Eduardo Mondlane University in Maputo. Over the last few weeks the original APOPO building has been extended and will have a dedicated GeneXpert laboratory as well as additional workspace. These are required for an increase in project activities as a result of the change of rat indication confirmation method from microscopy to GeneXpert testing.

APOPO has already purchased a 16-module GeneXpert machine, which will allow APOPO to confirm close to 100 samples daily. Medecins Sans Frontieres (MSF) operates in many of Maputo’s clinics and will supply APOPO with GeneXpert cartridges for confirmation testing of samples coming from those clinics. APOPO is also discussing with the Maputo City Health Directorate to integrate APOPO’s laboratory in the National Health System network, so it can also receive cartridges straight from the Ministry of Health depots. The new GeneXpert machine is already set up in APOPO’s newly built laboratory, being the first 16-module machine in the Republic of Mozambique, and positioning APOPO as a key partner for the Maputo City Health Directorate. This is a significant step forward in the intention of the Maputo health authorities to reach complete GeneXpert coverage in the city.

APOPO thanks MSF Switzerland as well as the Maputo City Health Directorate for their support.

APOPO would like to recognize the partnership and commitment of our donors and partners
whose generous support make our life-saving work possible.