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Table of Contents
                            ABSTRACT BOOK 2012
43rd World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease (The Union)
	Union Web site
	44th Union World Conference on Lung Health, Paris, 2013
Vol 16  No 12  Supplement 1         The International Journal of Tuberculosis and Lung Disease
	Aims and Scope
	IJTLD online
CONTENTS
SYMPOSIA
THURSDAY, 15 NOV
	TB REACH: RESULTS FROM TUBERCULOSIS CASE FINDING INNOVATIONS IN THE FIRST TWO WAVES
	PHARMACISTS CAN HELP PROTECT TUBERCULOSIS DRUGS AND DO MORE TO SUSTAIN TUBERCULOSIS CONTROL: HOW CAN TUBERCULOSIS PROGRAMMES ENGAGE THEM?
	PROGRESS AND PROSPECTS: SUSTAINABILITY OF TUBERCULOSIS VACCINE DEVELOPMENT
	CHALLENGES IN THE DESIGN AND CONDUCT OF CLINICAL TRIALS FOR IMPROVING THE TREATMENT OF TUBERCULOSIS
	CAPITALISING CORPORATE SECTOR STRENGTHS TO ADDRESS TUBERCULOSIS AND HIV CHALLENGES
	ENSURING THE QUALITY OF TUBERCULOSIS LABORATORY SERVICES
	WHO HAS THE RIGHT TO HEALTH CARE, AND WHO IS RESPONSIBLE FOR ENSURING IT?
	THE ROLE OF COMMUNICATIONS IN CHANGING SOCIAL NORMS AND PROMOTING PUBLIC HEALTH POLICY IN LOW- AND MIDDLE-INCOME COUNTRIES
	WHO GUIDELINES ON SCREENING FOR ACTIVE TUBERCULOSIS
	ROLLING OUT XPERT® MTB/RIF: BRINGING DONORS, LABORATORIES AND PROGRAMMES TOGETHER FOR SUSTAINABILITY
	TRANSLATING TUBERCULOSIS PROJECTS INTO SUSTAINABLE TUBERCULOSIS PROGRAMMES: LESSONS FROM THE WHO-CIDA INITIATIVE
	TUBERCULOSIS SCREENING PROGRAMMES FOR HEALTHY MIGRATION AND STRENGTHENING TUBERCULOSIS CONTROL PROGRAMMES
	CHALLENGES AND SOLUTIONS FOR SUSTAINABLE TUBERCULOSIS AND TB-HIV CARE AMONG MIGRANTS AND MARGINALISED POPULATIONS
	BUILDING NATIONAL AND INTERNATIONAL PARTNERSHIPS TO ENSURE A SUSTAINABLE RESPONSE TO TUBERCULOSIS CHALLENGES
	A REALISTIC ASSESSMENT OF PROGRAMMATIC MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS (PMDT) SCALE-UP ACHIEVEMENTS, CHALLENGES AND OPPORTUNITIES
	MONITORING THE GLOBAL TOBACCO EPIDEMIC: STRATEGIC AND SUSTAINABLE SYSTEMS
	TUBERCULOSIS IN PRISONS: BREAKING THE CYCLE THROUGH INTEGRATION WITH COMMUNITY HEALTH SERVICES
FRIDAY, 16 NOV
	STATE OF THE ART ON CHILDHOOD TUBERCULOSIS TREATMENT AND DIAGNOSTICS
	TUBERCULOSIS AND DIABETES COLLABORATIVE ACTIVITIES: POLICY AND PRACTICE
	SAVING LIVES IN AREAS OF CONFLICT OR DISASTER: PARTNERING FOR RESULTS
	THINKING OUT OF THE BOX: CATALYSING INNOVATIONS AND EXPANSION OF mHEALTH IN TUBERCULOSIS CARE
	FORMER TUBERCULOSIS PATIENTS: EFFECTIVE COMMUNITY ENGAGEMENT AND LESSONS LEARNT
	ADVANCING MOLECULAR DIAGNOSIS WITH A SUSTAINABLE APPROACH TO IMPACT PATIENT CARE
	NON-COMMUNICABLE DISEASES AND CHRONIC RESPIRATORY DISEASES: GLOBAL BURDEN AND RESPONSE
	THE IMPORTANCE OF PUBLIC POLICY ON TOBACCO CONTROL: A GLOBAL VIEW
	NGO AND CIVIL SOCIETIES’ ROLE IN SUSTAINABLE APPROACHES FOR SCALING UP DRUG-RESISTANT TUBERCULOSIS PROGRAMMES
	ADVANCES IN THE TREATMENT OF MDR-TB: CURRENT RECOMMENDATIONS, SHORT COURSE MDR-TB REGIMENS AND NEW DRUGS
	EVALUATION OF TOBACCO CONTROL PROGRAMMES: EXPERIENCES TO IMPROVE THE EFFECTIVENESS OF RESOURCES USED AND SUSTAINABILITY
	IMPLEMENTATION AND EVALUATION OF TUBERCULOSIS CONTACT INVESTIGATION IN HIGH-BURDEN SETTINGS
	BEST PRACTICE IN THE APPLICATION OF NEW TECHNOLOGIES AND INNOVATIONS
	NUTRITIONAL SUPPORT IN THE PREVENTION OF TUBERCULOSIS AND WHO GUIDELINES FOLLOWING TUBERCULOSIS DIAGNOSIS
	USING GEOGRAPHIC INFORMATION SYSTEMS (GIS): NEW POSSIBILITIES FOR IMPROVING TUBERCULOSIS CONTROL PROGRAMMES
	OCCUPATIONAL HEALTH ENCOURAGEMENT: A PATHWAY TO ATTAINING SUSTAINABILITY
	ENSURING SUSTAINABLE SURVEILLANCE, DIAGNOSIS, PREVENTION AND CONTROL OF ZOONOTIC TUBERCULOSIS
SATURDAY, 17 NOV
	SUSTAINABLE TUBERCULOSIS LABORATORY NETWORKS
	CHANGING THE LANDSCAPE IN TUBERCULOSIS: HOW CIVIL SOCIETY AND COMMUNITIES CAN INCREASE THE IMPACT OF THE GLOBAL FUND IN COUNTRIES
	PALLIATIVE CARE IN DRUG-RESISTANT AND COMPLICATED TUBERCULOSIS: MODELS OF COMMUNITY-BASED CARE
	SUSTAINABLE PRACTICES, BUILDING DESIGN, AND ENGINEERING TO REDUCE TUBERCULOSIS TRANSMISSION IN RESOURCE-LIMITED SETTINGS
	BIOMARKERS IN TUBERCULOSIS: FROM DISCOVERY TO CLINICAL APPLICATION
	HEALTH SYSTEM STRENGTHENING FOR CHILDHOOD TUBERCULOSIS: POLICY TO PRACTICE
	TOBACCO TAXATION: A SUSTAINABILITY TOOL FOR TOBACCO CONTROL AND HEALTH PROGRAMMES
	COMMUNITY PARTICIPATION AND COMMUNITY ADVISORY BOARDS: PATHS FOR EFFECTIVE AND SUSTAINABLE TUBERCULOSIS CONTROL INTERVENTIONS
	MODELS OF CARE AND ENGAGEMENT FOR SUSTAINING A COMPETENT WORKFORCE FOR MDR-TB-HIV CARE AND MANAGEMENT
	CONTACT INVESTIGATION: OPERATIONAL RESEARCH TO INCREASE CASE DETECTION AND DRIVE SUSTAINABILITY
	TRANSLATING POLICIES INTO PRACTICE: BUILDING LASTING SOLUTIONS FOR TUBERCULOSIS LABORATORY NETWORKS IN COUNTRIES
	MANAGEMENT OF COMMON RESPIRATORY INFECTIONS IN CHILDREN
	COUNTERING TOBACCO INDUSTRY INTERFERENCE IN TOBACCO CONTROL: SUSTAINING OUR EFFORTS THROUGH COLLABORATION
ABSTRACT PRESENTATIONS
THURSDAY, 15 NOV
ORAL PRESENTATIONS
	MODERN MOLECULAR TECHNOLOGIES IN TUBERCULOSIS DIAGNOSIS
	HIV TESTING AND TUBERCULOSIS SCREENING: THE COMPLETE PACKAGE
	PREVENTIVE THERAPY, POPULATIONS AND PHARMACOKINETICS: SPECIAL ISSUES IN TB-HIV
	PNEUMONIA IN ADULTS AND CHILDREN: PREVENTING DEATHS
	MONEY, MEETINGS AND TRAINING: BEST PRACTICES TO IMPROVE TUBERCULOSIS CARE
	MOTHERS, MIGRANTS, MILITARY AND MORE: TUBERCULOSIS IN SPECIAL POPULATIONS
POSTER DISCUSSIONS
	TUBERCULOSIS DIAGNOSTICS: CULTURE AND RAPID DETECTION–1
	TUBERCULOSIS LABORATORY NETWORK: MANAGEMENT OF EXTERNAL QUALITY ASSESSMENT
	MOLECULAR GENETIC AND OTHER RAPID DRUG SUSCEPTIBILITY TESTING
	B.R.I.C. AND BEYOND: SPECIAL POPULATIONS IN EMERGING AND HIGH-INCOME COUNTRIES
	TOBACCO CESSATION
	EPIDEMIOLOGY: TUBERCULOSIS IN HIGH- AND LOW-BURDEN COUNTRIES–1
	TRAINING AND KNOWLEDGE ASSESSMENT
	MEDICAL MANAGEMENT OF TUBERCULOSIS–1
	PUBLIC POLICY–1
	TB-HIV PHARMACOLOGY AND CLINICAL ISSUES
	EXPANSION OF THE STOP TB STRATEGY– 1
	IMPROVING TUBERCULOSIS SURVEILLANCE IN CHILDREN
	TOBACCO BURDEN AND SURVEILLANCE
	MULTIDRUG-RESISTANT TUBERCULOSIS: CIVIL SOCIETY, COSTS, COUNSELLING AND CASE FATALITY
	MULTIDRUG-RESISTANT TUBERCULOSIS: TREATMENT OUTCOMES
	MULTIDRUG-RESISTANT TUBERCULOSIS: FOCUS ON SURVEILLANCE
	TUBERCULOSIS MANAGEMENT: FOOD SECURITY AND COMMUNITY ISSUES
	TUBERCULOSIS MANAGEMENT: INNOVATIONS IN COMMUNICATION
FRIDAY, 16 NOV
ORAL PRESENTATIONS
	CO-LOCATION AND INTEGRATION OF TB-HIV SERVICES: BREAKING THE BARRIERS
	CHILDHOOD TUBERCULOSIS IN 
HIGH-BURDEN SETTINGS
	CURES, DEATHS AND FAILURES: ISSUES IN THE MANAGEMENT OF TUBERCULOSIS
	NEW FRONTIERS IN THE MANAGEMENT OF MDR- AND XDR-TB
	NEWER TUBERCULOSIS DIAGNOSTICS: ROLLING OUT AND THEIR IMPACT
	STIRRING IT UP: LABS, PHARMACIES AND MOTORCYCLE RIDERS IN THE PUBLIC-PRIVATE MIX
POSTER DISCUSSIONS
	MOLECULAR EPIDEMIOLOGY–1
	OCCUPATIONAL HEALTH AND INFECTION CONTROL
	IMMUNOLOGY: PATHOGENESIS AND VACCINES
	MPOWER AND TOBACCO CONTROL POLICIES–1
	ADVOCACY AND PUBLIC EDUCATION
	EPIDEMIOLOGY: TUBERCULOSIS IN HIGH- AND LOW-BURDEN COUNTRIES–2
	MEDICAL MANAGEMENT OF TB–2
	STOP TB STRATEGY PUBLIC-PRIVATE MIX–1
	PUBLIC POLICY–2
	SURVEILLANCE, TUBERCULOSIS SCREENING AND HIV TESTING
	EXPANSION OF THE STOP TB STRATEGY–2
	IMPROVING DIAGNOSIS AND TREATMENT OF CHILDHOOD TUBERCULOSIS
	MULTIDRUG-RESISTANT TUBERCULOSIS: FOCUS ON LABORATORIES
	MULTIDRUG-RESISTANT TUBERCULOSIS: CLINICAL ASPECTS
	TUBERCULOSIS MANAGEMENT: COSTS, SMOKING AND MORE
	MULTIDRUG-RESISTANT TUBERCULOSIS: PROGRAMMATIC ASPECTS
	MANAGING ASTHMA IN ADULTS AND CHILDREN
	DIABETES AND TUBERCULOSIS/NON-COMMUNICABLE DISEASE/CO-MORBIDITIES
SATURDAY, 17 NOV
ORAL PRESENTATIONS
	TUBERCULOSIS OUTBREAKS AND CONTACT INVESTIGATIONS
	TUBERCULOSIS HOTSPOTS: FROM THE GENOME TO THE COMMUNITY
	TB-HIV: THE PROMISE OF LIFE B
UT THE REALITY OF DEATH
POSTER DISCUSSIONS
	MOLECULAR EPIDEMIOLOGY–2
	TB DIAGNOSTICS: CULTURE AND RAPID DETECTION–2
	EXPANSION OF THE STOP TB STRATEGY–3
	TUBERCULOSIS IN PRISONS
	EPIDEMIOLOGY: TUBERCULOSIS IN HIGH- AND LOW-BURDEN COUNTRIES–3
	MEDICAL MANAGEMENT OF TUBERCULOSIS–3
	STOP TB STRATEGY PUBLIC-PRIVATE MIX–2
	COMMUNITY CONTRIBUTIONS TO TUBERCULOSIS CONTROL
	INTEGRATION AND CO-LOCATION
	MPOWER AND TOBACCO CONTROL POLICIES–2
	MANAGEMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS AND CONTACTS
	NEW APPROACHES TO TUBERCULOSIS PREVENTION IN CHILDREN
	ENVIRONMENTAL AND OTHER DETERMINANTS OF LUNG HEALTH
	MULTIDRUG-RESISTANT TUBERCULOSIS: FOCUS ON SOCIAL AND COMMUNITY SUPPORT
	TUBERCULOSIS MANAGEMENT: LABORATORY, MONITORING AND SURVEILLANCE
	TUBERCULOSIS MANAGEMENT: HEALTH SYSTEMS AND HUMAN RESOURCES
	MEDICAL MANAGEMENT/TUBERCULOSIS OUTBREAK AND CONTACT INVESTIGATION
	TUBERCULOSIS: PUBLIC HEALTH PRACTICE
                        
Document Text Contents
Page 1

The

International

Journal of Tuberculosis

and Lung Disease

V O L U M E 1 6

N U M B E R 1 2

D E C E M B E R 2 0 1 2

S U P P L E M E N T 1

P A G E S S 1 – S 4 5 0

I S S N 1 0 2 7 3 7 1 9

The Offi cial Journal of the International Union Against Tuberculosis and Lung Disease

A B S T R A C T B O O K

43rd World Conference
on Lung Health of the

International Union Against

Tuberculosis and Lung Disease (The Union)

KUALA LUMPUR � MALAYSIA
13�17 NOVEMBER 2012

Page 2

The
International

Journal of Tuberculosis
and Lung Disease S U P P L E M E N T 1

V O L U M E 1 6 N U M B E R 1 2 D E C E M B E R 2 0 1 2

SYMPOSIA
THURSDAY 15 NOVEMBER 2012
S1 TB REACH: results from tuberculosis case � nding

innovations in the � rst two waves
S3 Pharmacists can help protect tuberculosis drugs and do

more to sustain tuberculosis control: how can
tuberculosis programmes engage them?

S4 Progress and prospects: sustainability of tuberculosis
vaccine development

S5 Challenges in the design and conduct of clinical trials for
improving the treatment of tuberculosis

S7 Capitalising corporate sector strengths to address
tuberculosis and HIV challenges

S8 Ensuring the quality of tuberculosis laboratory services
S10 Who has the right to health care, and who is responsible

for ensuring it?
S11 The role of communications in changing social norms

and promoting public health policy in low- and
middle-income countries

S12 WHO guidelines on screening for active tuberculosis
S13 Rolling out Xpertfi MTB/RIF: bringing donors, laboratories

and programmes together for sustainability
S16 Translating tuberculosis projects into sustainable

tuberculosis programmes: lessons from the WHO-CIDA
initiative

S18 Tuberculosis screening programmes for healthy migration
and strengthening tuberculosis control programmes

S20 Challenges and solutions for sustainable tuberculosis and
TB-HIV care among migrants and marginalised
populations

S21 Building national and international partnerships to
ensure a sustainable response to tuberculosis challenges

S23 A realistic assessment of programmatic management of
drug-resistant tuberculosis (PMDT) scale-up
achievements, challenges and opportunities

S24 Monitoring the global tobacco epidemic: strategic and
sustainable systems

S26 Tuberculosis in prisons: breaking the cycle through
integration with community health services

FRIDAY 16 NOVEMBER 2012
S28 State of the art on childhood tuberculosis treatment

and diagnostics
S29 Tuberculosis and diabetes collaborative activities: policy

and practice
S32 Saving lives in areas of con� ict or disaster: partnering

for results
S33 Thinking out of the box: catalysing innovations and

expansion of mHealth in tuberculosis care
S36 Former tuberculosis patients: effective community

engagement and lessons learnt
S37 Advancing molecular diagnosis with a sustainable

approach to impact patient care
S39 Non-communicable diseases and chronic respiratory

diseases: global burden and response

S40 The importance of public policy on tobacco control:
a global view

S40 NGO and civil societies� role in sustainable approaches
for scaling up drug-resistant tuberculosis programmes

S42 Advances in the treatment of MDR-TB: current
recommendations, short course MDR-TB regimens and
new drugs

S44 Evaluation of tobacco control programmes: experiences
to improve the effectiveness of resources used and
sustainability

S45 Implementation and evaluation of tuberculosis contact
investigations in high-burden settings

S47 Best practice in the application of new technologies
and innovations

S48 Nutritional support in the prevention of tuberculosis
and WHO guidelines following tuberculosis diagnosis

S49 Using geographic information systems (GIS): new
possibilities for improving tuberculosis control
programmes

S50 Occupational health encouragement: a pathway to
attaining sustainability

S52 Ensuring sustainable surveillance, diagnosis, prevention
and control of zoonotic tuberculosis

SATURDAY 17 NOVEMBER 2012
S54 Sustainable tuberculosis laboratory networks
S55 Changing the landscape in tuberculosis: how civil society

and communities can increase the impact of the Global
Fund in countries

S57 Palliative care in drug-resistant and complicated
tuberculosis: models of community-based care

S59 Sustainable practices, building design, and engineering
to reduce tuberculosis transmission in resource-limited
settings

S61 Biomarkers in tuberculosis: from discovery to clinical
application

S62 Health system strengthening for childhood tuberculosis:
policy to practice

S64 Tobacco taxation: a sustainability tool for tobacco control
and health programmes

S65 Community participation and community advisory
boards: paths for effective and sustainable tuberculosis
control interventions

S65 Models of care and engagement for sustaining a
competent workforce for MDR-TB-HIV care and
management

S67 Contact investigation: operational research to increase
case detection and drive sustainability

S68 Translating policies into practice: building lasting
solutions for tuberculosis laboratory networks
in countries

S71 Management of common respiratory infections
in children

S72 Countering tobacco industry interference in tobacco
control: sustaining our efforts through collaboration

Page 227

Abstract presentations, Friday, 16 November S223

detecting resistance to AGs. The average time from
baseline sputum collection to second line DST results
was 87 days as compared to 12 days for MTBDRsl
results.
Conclusions: The MTBDRsl assay had a rapid turn
around time; however results were not optimal as
compared to conventional second line DST. Further
AQ and FG molecular resistance mutations need to
be included in the MTBDRsl to improve test perfor-
mance and clinical utility.

OP-182-16 A rapid detection of extensively
drug-resistant tuberculosis: comparison of
the genotype MTBDRsl assay with indirect
second-line susceptibility testing
Y Coovadia, M Pillay, A Kajee, K Mlisana. Microbiology,
University of KwaZulu-Natal, Durban, South Africa.
e-mail: [email protected]

Background: Extensively drug-resistant TB (XDR-
TB) is a serious global health concern. Conventional
indirect susceptibility testing for second-line drugs
(ofl oxacin, kanamycin) is constrained by the rela-
tively slow growth of M. tuberculosis. Rapid molecu-
lar methods to detect drug resistance to second line
drugs are necessary to optimize anti-tuberculosis
treatment and to avoid the transmission of resistant
strains. The Genotype MTBDRsl assay was evaluated
for its performance for the rapid detection of XDR-
TB in MGIT cultures.
Design/methods: The Genotype MTBDRsl assay
was performed on 60 well characterised MGIT cul-
tures comprising of XDR, MDR and mono-resistant
strains of M. tuberculosis. The investigator perform-
ing the Genotype MTBDRsl assay was blinded to the
culture susceptibility results.
Results: Preliminary data: The Genotype MTBDRsl
identifi ed XDR-MTB in 43 of the 60 MGIT cultures.
In all 43 isolates the following mutations were identi-
fi ed: a single mutation (A90V) in the gyrase A sub-
unit coding for fl uoroquinolone resistance, a muta-
tion in nucleic acid position 1401 (A1401G) of the
rrs gene coding for an aminoglycoside/cyclic peptide
resistance and a mutation in codon 306 of the embB
gene coding for ethambutol resistance. The second-
line indirect susceptibility testing confi rmed XDR in
all 43 MTB isolates with growths at 2 �g/ml for
ofl oxacin, 5 �g/ml for kanamycin and 7.5 �g/ml for
ethambutol. Of the 17 non XDR-TB isolates, the as-
say detected no mutations in genes that code for fl uo-
roquinolone, aminoglycoside and ethambutol resis-
tance in 14 isolates. These were confi rmed to be fully
susceptible by the indirect susceptibility testing. The
remaining 3 were found to be only resistant to a fl uo-
roquinlone with a mutation in codon 91 (S91P). One
of these three isolates was found to be susceptible to
ofl oxacin on the second-line susceptibility agar.

Conclusion and recommendations: Genotype MTB-
DRsl assay allows for the rapid diagnosis of XDR-TB
in cultures.

OP-183-16 Responsible technology: success,
challenges and key lessons from a novel
Xpert® MTB/RIF deployment at a major
public event in South Africa
L Page-Shipp,1 W Stevens Denooy,2,3 L Scott,3 F Olsen,2
B Sehume,1 H Kisbey-Green,1 L D Mametja,4 D Clark.1
1Health Programmes, The Aurum Institute, Johannesburg,
2Priority Programme, National Health Laboratory Service,
Johannesburg, 3Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, 4TB, National
Department of Health, Pretoria, South Africa.
e-mail: [email protected]

Background: At the 2012 South African World TB
Day public event, an unprecedented deployment of
Xpert® MTB/RIF testing was offered to TB symp-
tomatic clients from gold mining and surrounding
communities. Considerations included effective TB
symptom screening; safe, effective sputum collection;
ensuring uninterrupted electricity supply; client track-
ing and provision of on-site results.
Intervention: TB symptomatic clients screened from
the presenting crowd were entered in a national ‘TB
suspect register’ and given a barcoded sputum sample
tracking pack and return time for results (3 hours
later). Facilities were provided for mouth rinsing and
sputum production in 8 private, ventilated gazebos.
Ten GeneXpert (Gx16) instruments were placed in 5
mobile units around a central outdoor sample pro-
cessing area. Each Gx was verifi ed with a dried cul-
ture spot panel and standard of practice testing was
performed. Results were printed and referral letters
given; 46 clinical and laboratory staff were deployed.
Results/lessons learnt: 597 (36%) of 1661 clients
screened were TB symptomatic. 532 of 591 (90%)
specimens received were resulted: 12 (2.3%) were
Mycobacterium tuberculosis-positive with one RIF
resistant; all TB� patients were appropriately re-
ferred. Of 59 specimens not resulted: 49 were due to
power supply (switch failure) to two Gx16 instru-
ments (9 clients were traced and samples repeated); 7
due to cartridge error; and 3 rejected (food contami-
nation, incorrect labelling). Administratively, 95%
(567/597) results were defi nitively linked to register
entries. Some clients expected immediate TB results
without the need to provide sputum.
Conclusions and key recommendations: Public event
Xpert MTB/RIF testing is feasible but the case fi nding
rate was low (2.3%). We recommend exploring en-
hanced symptom screening algorithms to improve pre-
test probability, improved management of client expec-
tations, cost effectiveness analysis, exploring alternate
electrical fail-safes and on-site data connectivity.

Page 228

S224 Abstract presentations, Friday, 16 November

OP-184-16 Does the introduction of the
Xpert® MTB/RIF test result in an increased
tuberculosis diagnostic yield in a routine
operational setting in Cape Town?
P Naidoo,1 E Du Toit,1 R Dunbar,1 J Caldwell,2 N Beyers,1
D A Enarson.3 1Desmond Tutu TB Centre, Stellenbosch
University, Cape Town, 2TB-HIV, City Health Directorate, Cape
Town, South Africa; 3TREAT TB, International Union Against
Tuberculosis and Lung Disease, Paris, France.
e-mail: [email protected]

Background: Xpert® MTB/RIF (Xpert) has been in-
troduced in South Africa as a screening test for all tu-
berculosis (TB) suspects, replacing smear microscopy.
Anticipated benefi ts include higher TB and multi-
drug resistant (MDR-TB) yields. This study aims to
evaluate whether the introduction of Xpert increased
TB and MDR-TB yields in a routine operational set-
ting in Cape Town.
Methods: TB yields were compared for 28 primary
health facilities using the Xpert algorithm and 48 fa-
cilities using the smear/culture algorithm during
O ctober–December 2011 (Algorithms in the Table).
Electronic TB results were imported from the Na-
tional Health Laboratory Services into an MS SQL
database. Only pre-treatment sputum results were in-
cluded in the analysis. Results were matched on
name, surname and age/birth date to individual sus-
pect level using Link Plus probabilistic software. Data
was analysed using STATA 10.
Results: Preliminary results are presented in the Table.
5006 suspects were evaluated in the Xpert facilities:
19.1% had Mycobacterium tuberculosis (MTB) com-
plex detected, 1.8% had a negative Xpert but posi-
tive culture. 1% of suspects had rifampicin resistance.
9886 suspects were evaluated in the smear/culture fa-
cilities: 10.8% were smear positive; 3.8% were smear
negative/culture positive and 4.8% had no smear re-
sult but were culture positive. 0.6% were diagnosed
with MDR-TB. The Xpert facilities had a TB yield of
20.9% compared to 19.3% for the smear/culture fa-
cilities (risk ratio 1.06, CI 1.0 1–1.12). Xpert facili-
ties had RIF resistant yield of 1.0% compared to an
MDR yield of 0.6% in the smear/culture facilities
(risk ratio 1.35, CI 1.09–1.67).

Table Comparison of TB yields in the Xpert MTB/RIF
algorithm and smear/culture algorithm

Conclusion: Whilst the introduction of Xpert MTB/
RIF test has resulted in increased TB and RIF resis-
tant yields, the operational signifi cance of these in-
creases is small; it may be of operational signifi cance
in settings without access to culture. Potential other
benefi ts in reducing time to treatment initiation need
to be explored.

STIRRING IT UP: LABS, PHARMACIES
AND MOTORCYCLE RIDERS IN THE
PUBLIC-PRIVATE MIX

OP-185-16 Strengthening of TB-HIV
coordination: involving NGOs through
public-private partnership
Y Dholakia, V Pawar. Tuberculosis, The Maharashtra State
Anti-TB Association, Mumbai, India.
e-mail: [email protected]

Aim: Tuberculosis is the most common cause of mor-
tality in HIV infected individuals in high prevalence
countries like India. Quality of life can be improved
through early identifi cation and improving access to
care. A public-private partnership was designed to
meet the objectives.
Methods: A three year public-private partnership
project, funded by GFATM III, was implemented be-
tween 2006 and 2009, in four districts of Maharash-
tra, India, to improve access to public health facilities
through community awareness and motivating refer-
rals. PLHIV and TB patients were engaged to moti-
vate patients attending integrated counseling and
testing centers (VCCTCs) and designated micros-
copy centers (DMCs) for cross referrals and adher-
ence to services. Community leaders and private health
providers were sensitized to issues around TB and
HIV/AIDS.
Observations: 357 outreach workers in four districts
of the state referred 17 200 individuals for voluntary
HIV testing, 866 were detected seropositive for HIV
(5.03%). During the same period, of the 32 549 TB
suspects referred for testing 4303 (13.2%) were diag-
nosed as TB.
Lessons learnt: NGOs, PLHIV and TB patients are
motivated to improve access to health care. Public
health facilities need to be fully operational; policies
and guidelines need to be formulated before partner-
ships are formed. Sustainable funding is essential to
effective implementation of projects and regular
monitoring and evaluation with appropriate budget
allocation should be inbuilt in the project.
Conclusion: Public-private partnerships can im-
prove access to care for TB and HIV infected indi-
viduals. Constant dialogue between all stake holders
is essential for successful implementation of such
partnerships.

Page 453

Abstract presentations, Saturday, 17 November S449

schemes provided by the government of India. Data
was collected through TB registers in CARE districts
of West Bengal. The risk of completing treatment for
those who were linked to welfare schemes was com-
pared to the risk of completing treatment for those
who were not linked in two quarters of 2010.
Results and lessons learnt: Category II patients who
were linked to welfare schemes were 28% more likely
to complete treatment than those who were not
linked to welfare schemes (RR = 1.28; P = 0.002).
There was no difference in treatment completion
rates in Category I patients.
Conclusions and key recommendations: Linking TB
patients to welfare schemes has the potential to re-
duce the treatment default rate by mitigating the fi -
nancial burden TB treatment causes. Advocacy and
linkage of TB patients to welfare schemes should be
scaled up and evaluated across India and beyond.

Page 454

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