Microscopic analysis of sputum smears at the national tuberculosis and leprosy reference laboratory in Kampala, Uganda. Photograph: World Lung Foundation
The cost of a highly accurate, rapid diagnostic test for tuberculosis (TB) has been reduced by 40% under a new agreement between the US government, the Bill and Melinda Gates Foundation, and the health financing mechanism, Unitaid.
GeneXpert, recommended by the World Health Organisation (WHO) in December 2010, provides a two-hour diagnosis of TB, the TB/HIV co-infection and drug-resistant TB. "To date, the high unit cost of Xpert cartridges … has proven a barrier to their introduction and widespread use in low- and middle-income countries. The new agreement will immediately reduce the cost of cartridges used to diagnose TB by more than 40%," Unitaid said on 6 August.
The cost of cartridges will drop from $16.86 (£10.75) to $9.98, and the price will not increase until 2022. According to the WHO Stop TB Partnership, 45 developing countries and those with a high TB burden will benefit from the price cut. Research suggests that increased use of the test in countries with high TB burdens could allow the rapid diagnosis of 700,000 cases of TB, and save health systems in low- and middle-income countries more than $18m in direct costs.
The test can be used outside conventional laboratories because it is self-contained and does not require specialised training. In countries such as Kenya, where delays in laboratory diagnosis lead to lack of follow-up and the continued spread of the disease, a cheaper rapid test is welcome.
"We have areas in the country where the TB burden is high and we have been unable to diagnose everybody as quickly as we would want. Now we have a perfect opportunity do that and ensure we diagnose and put people on treatment," Dr Joseph Sitienei, head of Kenya's national leprosy, TB and lung disease programme in the ministry of health, told IRIN/PlusNews.
Kenya is already using the rapid test in a limited number of health facilities, but Sitienei said the price cut would enable the government to use it much more widely. "Currently, everybody who is diagnosed with TB or TB/HIV co-infection is put on treatment. Even with increased diagnosis, we [the government] have the capacity to ensure that everybody who needs treatment has it," he said. "What this means for us is that even facilities without laboratories will diagnose."
The test will be particularly useful in prolonging the lives of people co-infected with TB and HIV – TB is the leading killer of people living with HIV. About half of all HIV-positive Kenyans are co-infected with TB, but only about 40% are properly diagnosed and treated, Sitienei said. "We have had many people with HIV die from TB – deaths that can be prevented with better diagnosis and treatment."
"This is a game-changer for TB and MDR-TB [multidrug-resistant TB] care delivery," Dr Mario Raviglione, director of the WHO Stop TB Department, said. "We see innovation happening in real time – scientific evidence rapidly translated into policy, policy quickly adapted into practice, and scale-up significantly accelerated by innovative funding mechanisms effectively addressing cost and affordability."
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