Milburn James, Ntwayagae Ookeditse, Ngoni Kebatshabile, Suresh Rachita, Lemme Neo, Northcott Cassie, Penney James, Kinsella Matthew, Mechie Imogen, Ensor Samuel, Chebani Tony, Grint Daniel, Tenforde Mark W, Avalos Ava, Ramaabya Dinah, Doyle Ronan, Mokomane Margaret, Mine Madisa, Kranzer Katharina, Jarvis Joseph N
Botswana Harvard Health Partnership, Gaborone, Botswana.
Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Open Forum Infect Dis. 2024 Aug 28;11(9):ofae489. doi: 10.1093/ofid/ofae489. eCollection 2024 Sep.
Tuberculous meningitis (TBM) disproportionately impacts high-HIV prevalence, resource-limited settings where diagnosis is challenging. The GeneXpert platform has utility in TBM diagnosis, but uptake remains limited. In Botswana, before the introduction of GeneXpert, tuberculosis (TB) testing was only available through mycobacterial culture at the National TB Reference Laboratory. Data describing routine use of Xpert MTB/RIF for cerebrospinal fluid (CSF) testing in resource-limited settings are scarce.
Electronic records for patients with CSF tested in government facilities in Botswana between 2016 and 2022 were obtained from a central online repository as part of ongoing national meningitis surveillance. Samples were excluded from 1 site where Xpert MTB/RIF is performed universally. The proportion receiving TB-specific investigation on CSF and the number positive for following increased Xpert MTB/RIF capacity were determined.
The proportion of CSF samples receiving TB-specific investigation increased from 4.5% (58/1288) in 2016 to 29.0% (201/693) in 2022, primarily due to increased analysis with Xpert MTB/RIF from 0.9% (11/1288) to 23.2% (161/693). There was an overall decline in the annual number of CSF samples analyzed, but the proportion with microbiologically confirmed TBM increased from 0.4% to 1.2%. The proportion of samples tested for TB that were collected from health care facilities >100 km from the National TB Reference Laboratory increased with Xpert MTB/RIF rollout from 65.9% (87/132) to 78.0% (494/633).
In Botswana, access to TB culture is challenging in remote populations; more accessible near-patient testing using Xpert MTB/RIF increased the number of patients receiving TB-specific testing on CSF and the number of confirmed TBM cases.
结核性脑膜炎（TBM）对艾滋病毒高流行率、资源有限且诊断具有挑战性的地区影响尤为严重。GeneXpert平台在TBM诊断中具有实用价值，但采用率仍然有限。在博茨瓦纳，在引入GeneXpert之前，结核病（TB）检测仅通过国家结核病参考实验室的分枝杆菌培养进行。关于在资源有限的环境中常规使用Xpert MTB/RIF进行脑脊液（CSF）检测的数据很少。
作为正在进行的全国脑膜炎监测的一部分，从一个中央在线存储库中获取了2016年至2022年期间在博茨瓦纳政府设施中进行CSF检测的患者的电子记录。从普遍进行Xpert MTB/RIF检测的1个地点排除样本。确定了接受CSF结核特异性调查的比例以及随着Xpert MTB/RIF检测能力增加后的阳性数量。
接受结核特异性调查的CSF样本比例从2016年的4.5%（58/1288）增加到2022年的29.0%（201/693），主要是由于使用Xpert MTB/RIF进行分析的比例从0.9%（11/1288）增加到23.2%（161/693）。分析的CSF样本年度数量总体下降，但微生物学确诊的TBM比例从0.4%增加到1.2%。随着Xpert MTB/RIF的推广，从距离国家结核病参考实验室>100公里的医疗机构采集的用于结核检测的样本比例从65.9%（87/132）增加到78.0%（494/633）。
在博茨瓦纳，偏远地区人群难以获得结核培养；使用Xpert MTB/RIF进行更易获得的即时检测增加了接受CSF结核特异性检测的患者数量以及确诊的TBM病例数量。
