Introduction of the Simple One-Step stool Xpert Ultra method to detect TB in children and adults

• Published in: The international journal of tuberculosis and lung disease Vol. 27; no. 1; pp. 19 - 27
• Main Authors: de Haas, P., Nhung, N. V., Hng, N. T., Hoà, N. B., Loan, N. B., Thanh, N. T. K., Gebhard, A., Slyzkyi, A., Tue, P. Q., H´ng, N. V., Hang, P. T., Ngoc, K. T. T., Tiemersma, E. W.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.01.2023; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Acceptability; Adult; Child; Childhood Tb; Children; Feces; HIV; Human immunodeficiency virus; Humans; Medical personnel; Mycobacterium tuberculosis; PLHIV; Pulmonary Tb; Rifampin; Signs and symptoms; Sos Stool; Sputum; Tb Diagnosis; Tuberculosis; Tuberculosis - diagnosis
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.22.0161

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.