Tuberculosis (TB) continues to be one of the major fatal infectious diseases in many of the world’s poorest countries, including Zimbabwe. The close relationship between HIV infection and increased susceptibility to TB and to TB mortality has been well established, and TB research remains a high priority area for BRTI. Research has focussed mainly on diagnostics, since early detection of TB infection is the essential step in effective treatment and control. The BRTI has worked closely with Ministry of Health and Child Care to improve access to TB diagnosis through training of Ministry staff in microscopy techniques, as well as in detection, identification and susceptibility testing of isolates. These activities in turn have provided opportunities for evaluation of contemporary strategies in case detection, through both active and passive case-finding. Studies have been both laboratory based – evaluation of the MODS assay for example, – and community-based with implementation science studies to identify the best ways in which to integrate molecular tools such as GeneXpert MTB/RIF into the diagnostic algorithms in different situations. Detection of TB in children is also an area where research is needed to identify the most effective strategies.
The BRTI has been the implementing Zimbabwe partner in a number of multi-country studies of TB diagnostics. The experiences it has gained in laboratory-based, community-based and qualitative studies are very useful in this context. The BRTI manages, through the Laboratory Manager, Mrs B. Makamure, and effective and efficient TB laboratory that receives accreditation from both local and international evaluation programmes.
Because of its experience in TB diagnostics in difficult settings, the BRTI was well placed to assist the Ministry in the design and conduct of the National TB Prevalence Survey in Zimbabwe.
While most cases of TB are susceptible to current first line treatment programmes, there is increasing concern about the spread of both multidrug resistant TB (MDR-TB) and extremely drug-resistant (XDR-TB) in southern Africa. Studies to identify the prevalence and distribution of MDR-TB have been carried out in those segments of the population most at risk of this infection.
The BRTI welcomes opportunities to collaborate in studies that will contribute to effective TB control in Zimbabwe and in the region. In the first instance, contact Dr J Mutsvangwa at the BRTI (email@example.com) .
Selected recent publications in TB:
Caligaro GL et al: Effect of new TB diagnostic technologies on community-based intensifies case-finding: a multi-centre randomised control trial. Lancet Infectious Diseases 2017;17:441-50
Chipinduro M et al: Stool Xpert MTB/RIF test for the diagnosis of childhood pulmonary TB at primary care clinics in Zimbabwe. Antimicrob Res and Infect ontrol 2017; 6:10-16
Metcalfe J et al: Xpert MTB/RIF detection of rifampin resistance and time to initiation of treatment in Harare, Zimbabwe. Int J TB and Lung Dis 2016;20:882-89
Peter JG et al: Effect on mortality of point of care, urine based lipoarabinomannan testing to guide TB treatment initiation in HIV-positive patients: a pragmatic parallel group, multi-country, open-bale clinical trial. Lancet 2016387:1187-97
Zijenah LS et al: Comparative performance characteristics of urine lipoarabinomannan strip test and sputum smear microscopy in hospitalised HIV infected patients with suspected TB in Harare, Zimbabwe. BMC Inf Dis 2016:16:20-28