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APOPO’s Tuberculosis (TB) Research and Training center was the first ever to evaluate rats as a diagnostic tool in human health. It takes about 9 months to fully train a Tuberculosis detection rat and once trained they can screen thousands of sputum samples every month. The research and development in this diagnostic approach seeks to curb the spread of this deadly disease.
The TB research and training facilities located in Morogoro, Tanzania, were established in 2005. The center has developed a solid empirical base and has received worldwide recognition for its accomplishments. International agencies and government institutions, such as the World Bank, the UBS Optimus Foundation, the National Institute of Health, the Belgian Development Cooperation and Development Innovative Ventures of the United States Agency for International Development (DIV-USAID) are among the supporters of the research Importantly, as scientific evidence strengthens regarding the methods used to screen TB with HeroRATs, so too does APOPO's operational impact.
APOPO's TB facilities (© Ville Palonen)
Over the last 10 years, APOPO has worked on improving its training techniques and evaluating its programs. In collaboration with our scientific partners, we have carried out numerous studies to examine the performance of our unique detection rats technology.
The TB center houses a distinctive laboratory with a fully functional sputum sample processing facility, complete with safety cabinet, autoclave, centrifuge, multiple infrared microscopes, and safety equipment. Also included in the center are four rat-training rooms: one for the pre-training stages, one for research activities, and two that are shared between research and operational activities. The center currently processes around 800 samples per week, collected from 28 public clinics in Dar es Salaam and Morogoro.
One of the training rooms (©Jeroen Van Loon)
The long-term mission of the TB research center is to validate a cost-effective and high-impact detection rats technology that may be used by independent entities in several other high TB-burden countries. Currently, the rats are an excellent add-on test to sputum smear microscopy, because at a relatively low cost we increase the case detection of new TB patients with over 40% in collaborating health clinics. Due to the speed and the low cost of the detection rats, this technology has also great potential to be the initial screening test when actively screening populations at high risk of TB.
APOPO has started an active case finding research project in 2015, evaluating the performance of the detection rats as a screening test in a high TB prevalence population. More than 2,500 prisoners are being tested for TB in Mozambique and Tanzania and the accuracy of the results will be compared with Xpert MTB/RIF as the reference standard. This study will help us to evaluate if the rats can be used as a the initial screening test.
APOPO has developed a five-year strategic research plan in order to receive accreditation from the World Health Organization (WHO). The plan is focused on completing a number of key studies aimed at submission to the WHO's Strategic and Technical Advisory Group for Tuberculosis. Key for APOPO is to prove that the detection rat technology is more accurate and cost-effective, easier to use, and shows better clinical outcomes for patients, compared to existing diagnostics.
Our research team completed a proof-of-principle study and a major evaluation that showed that detection rats have a higher sensitivity than Ziehl-Neelsen microscopy when compared to solid culture. One of the major clinical studies initiated by APOPO in 2014 endeavored to determine the accuracy of detection rats in a population of presumptive TB patients when compared with Xpert MTB/RIF and liquid and solid culture as the reference standard.
In a modeling study the cost-effectiveness of the detection rats is being investigated. This study will provide evidence for APOPO and for policy makers on how the TB detection rats can be best embedded in a diagnostic pathway (e.g. as an add-on test or a triage test). For this study, we are collaborating with the Amsterdam Institute for Global Health and Development.
In parallel to the clinical and cost-effectiveness research, we are also conducting behavioral and basic research in order to improve on the clinical studies and we're always exploring different opportunities for the detection rats technology.
In 2014, APOPO installed a TB Scientific Advisory Committee, consisting of a multidisciplinary team of international TB experts. This committee provides scientific and medical credibility to the program and research output, to advise on the long-term strategic research planning, and to identify new opportunities for research, funding, and partnerships.