Entry for:TSANZ 50th Anniversary Benevolent Grant
1. Summary of your project
Tuberculosis is highly endemic in the Solomon Islands. It typically affects the lungs and can result in permanent lung damage, particularly if the diagnosis or treatment is delayed.
For people with multidrug resistance, the deadliest form of the disease, traditional culture methods take up to eight weeks and require skilled lab staff and expensive equipment. This year, a new test (Gene Xpert OMNI) will be able to detect the disease using a battery-operated cartridge system in just 30 minutes. I would like to purchase this equipment for Gizo hospital in the western province of the Solomon Islands.
2. Outline of your proposal
Outline of Project
To purchase new equipment to and train local staff of Gizo hospital to rapidly diagnose pulmonary tuberculosis, (including multidrug resistant disease) in a resource limited setting of the western province of the Solomon Islands.
GeneXpertTM Omni for Mycobacterium tuberculosis diagnosis by Cepheid USA
This is a true “point-of care” test that improves on the established GeneXpertTM system that has been used and recommended by the World Health Organization for the past 6 years for the diagnosis of both drug susceptible and multidrug resistant tuberculosis 1,2. The GeneXpertTM Omni does not require mains power as it operates using battery technology. The testing time has been reduced from 2 hours per test to just 30 minutes. The OMNI unit is also smaller and more portable. This allows the subject to wait for a diagnosis at the same location in which they have sort care (not at a remote testing facility).
The applicant is a staff specialist respiratory physician at St Vincent’s hospital Sydney and is the clinical lead for the tuberculosis service at the hospital. Whilst St Vincent’s hospital has an outreach program with Gizo hospital in the Solomon Islands, (with a junior medical officer rotating there each term), there is currently no existing program relating to tuberculosis or the department of respiratory medicine.
The GenExpert TM, molecular based technology has revolutionized the diagnosis of tuberculosis. Previously reliant on sputum smear microscopy followed by solid or liquid culture based techniques to determine drug susceptibility testing, the diagnosis of drug resistance would take several weeks. In addition, because of the specialized skills and high cost to perform these tests in resource limited settings such as the Solomon Islands, these traditional tests are often not performed. Consequently, the diagnosis of tuberculosis (and drug resistance) was frequently missed.
It seems obvious, but failure to test for drug resistance will more than likely result in failure to diagnose (and treat) the disease. Recent research suggests that delayed diagnosis of multidrug resistant tuberculosis is likely to be the reason for greater chronic respiratory sequelae of the disease, including chronic obstructive pulmonary disease 3.
Aus $5,000 GenExpert TM OMNI
Aus $3,000 (cartridges)
Aus $2,000 Training expenses to train local health care workers in Solomon Islands
Gizo hospital is situated in the capital of the western province of the Solomon Islands. The hospital has 60 beds and serves a surrounding population of approximately 70,000 people. Tuberculosis is common with an estimated incidence of 84 per 100,000 4. There were no cases of
multidrug resistant tuberculosis reported in 2014, however this may be due to a lack of diagnostic testing for the disease.
1. Lawn SD, Nicol MP. Xpert® MTB/RIF assay: development, evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance. Future microbiology. 2011 Sep;6(9):1067-82.
2. World Health Organization. Policy statement: automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MT.
3. Byrne AL, Marais BJ, Mitnick CD, Garden FL, Lecca L, Contreras C, Yauri Y, Garcia F, Marks GB. Chronic airflow obstruction after successful treatment of multidrug-resistant tuberculosis. ERJ open research. 2017 Jul 1;3(3):00026-2017.
World Health Organization Report. Available online at; https://extranet.who.int/sree/Reports?op=Replet&name=/WHO_HQ_Reports/G2/PROD/EXT/TBCountryProfile&ISO2=sb&outtype=pdf