Unlocking the potential of new tech to tackle tuberculosis in South Africa

Tuberculosis (TB) is a leading cause of death in South Africa, killing over 60,000 people in 2020. New technologies have the potential to speed up diagnosis and treatment, cut TB transmission and improve patient care. But these life-saving innovations have not yet been implemented effectively in the places that need them most.

Under South Africa’s National Priority Programmes, a team of researchers have been working together to evaluate and advance several new technologies that will help the country deliver accurate, affordable, and accessible TB diagnostic services and patient care.

Scientists from South Africa’s University of the Witwatersrand and the London School of Hygiene and Tropical Medicine in the UK have helped to rollout the latest version of a rapid molecular test called Xpert Ultra. This included quality control monitoring of TB tests and training healthcare professionals on how to use the new technology and interpret the results.

Previous methods, sampling sputum or doing chest x-rays, could take weeks to detect TB and are not always accurate. This highly sensitive test produces results in a matter of hours. Patients can receive their diagnosis and start treatment quickly, reducing the chance of TB spreading in the community.

The Xpert TB dashboard links diagnostic tools like the Xpert Ultra from a central database. Researchers analysed the millions of test results fed into this system to trace TB cases and identify transmission hotspots across South Africa. This near real-time, remote monitoring of results provides actionable data to clinicians, patients, and national monitoring and evaluation teams so that effective TB treatment and prevention measures can be implemented.

The team have also helped to integrate TB and HIV diagnostic services. People living with HIV are particularly vulnerable to TB and represent roughly 70% of cases each year. Medical care for patients with HIV-associated TB infection is often managed separately, which can delay diagnosis and treatment and risk lives. But now the GeneXpert technology designed for the Xpert Ultra, can also measure HIV viral load using the Xpert HIV-1 test, which runs on the same platform used for TB diagnosis. The team have tested the viability of implementing the technology in different settings, to ensure this innovation will lead to a more joined-up and cost-effective approach to patient care.

To date, the TB diagnostic services have been scaled to more than 207 laboratories and approximately 3,900 facilities across South Africa through the wider National Health Laboratory Services. Scientific evidence-based data from the implementation of these new technologies has influenced policy on TB diagnostic and patient care, not only in South Africa but in global forums such as the World Health Organisation.

When the COVID-19 pandemic hit, scientists used the diagnostic tools and services established during the project to predict COVID-19 waves at least 2 weeks before they happened. The team also evaluated the effectiveness of COVID-19 diagnostic tests.

Collaboration has been key to this project’s success, combining the UK’s knowledge of and access to new TB diagnostics with the South African team’s extensive experience working with TB on the ground. Expertise from across the spectrum of infectious disease, data science, machine learning, artificial intelligence and more were brought to bear on the problem. Science partnerships like this will ensure that countries most affected by infectious diseases can contribute to, and fully benefit from, the latest innovations in healthcare.

“The legacy of this partnership is the technology supported system. It can be applied more broadly to other diseases or conditions to turn data into intelligence for optimising disease prevention and treatment strategies in real-time.”  Professor Rosanna Peeling, Professor and Chair of Diagnostics Research at the London School of Hygiene and Tropical Medicine and Director of the International Diagnostic Centre

 

Find out more about the project in this video.

Technology Supported Systems for Rapid Impact on TB Control

Project leads: Professor Wendy Stevens, University of the Witwatersrand and the National Health Laboratory Services, South Africa and Professor Rosanna Peeling, London School of Hygiene and Tropical Medicine, UK

Supporting partners: Professor Lesley Scott (University of the Witwatersrand, South Africa), Dr Pedro da Silva (University of the Witwatersrand, South Africa), and Professor David Moore (London School of Hygiene and Tropical Medicine, UK)

Supporting institutions: National Health Laboratory Service, Foundation for Innovative New Diagnostics, industry and clinical partners

Delivery partners: Medical Research Council, part of UK Research and Innovation, and the South African Medical Research Council, South Africa