Introduction of the Simple One-Step stool Xpert Ultra method to detect TB in children and adults
Petra de Haas, N. V. Nhung, N. T. Hng, N. B. Hoà, N. B. Loan, Nguyen Thi Kim Thanh, Agnes Gebhard, Andrii Slyzkyi, P. Q. Tue, N. V. H ́ng, Putheary Hang, Khiếu Thị Thúy Ngọc, Edine Tiemersma
Abstract
SETTING: In 2020, the National TB Programme (NTP) of Vietnam conducted an implementation pilot of the Simple One-Step (SOS) stool processing method using Xpert ® MTB/RIF Ultra (Ultra) among children and people living with HIV (PLHIV) with signs and symptoms of TB. DESIGN and OBJECTIVES: Using data from this pilot and collecting information on healthcare workers´ (HCWs) perceptions, we assessed the feasibility, acceptability and potential impact of routine stool testing for TB. RESULTS: HCWs perceived collection of stools from children as least stressful of all sample types, stool processing as acceptable and the SOS stool method as easy to perform. After a 3-month induction period, the proportion of initial non-determinate Ultra stool tests was less than 5%. Combined Ultra testing of a respiratory sample and stool resulted in an increase in the proportion of bacteriologically confirmed TB among PLHIV and children by respectively 4.1% (95% CI 1.6–6.6) and 3.9% (95% CI 1.6–6.2). Among children, Mycobacterium tuberculosis was more often detected in stool (26.1%) than in respiratory samples (23.4%) ( P = 0.06), including one child with rifampicin resistance. CONCLUSION: Stool testing can be feasibly implemented both in adult PLHIV and in children in routine settings, providing a non-invasive alternative sample type for the diagnosis of TB for patients who cannot produce sputum.