Stool simple one step GeneXpert enhances pediatric TB case notification in Malawi
Challenge / Problem Overview
Childhood TB case notification remains a challenge in Malawi, with childhood TB contributing only 7% of overall TB notifications in 2023. This low figure reflects the difficulty children face in providing sputum samples for TB diagnosis, compounded by the disease’s paucibacillary nature in this demographic, making diagnosis challenging. The World Health Organization recommended using stool samples as an alternative specimen for diagnosing TB in children in 2021.
Approach
Following a successful pilot study in eight sites, Malawi has made strides towards integrating stool based GeneXpert testing into routine pediatric TB services. With the technical support of the USAID/LEAP Local Technical Advisor, a comprehensive rollout plan for the Stool Simple One Step (SOS) method was developed in consultation with key stakeholders, including the National TB Reference Lab and TB Local Area Network One and Two projects. The phased rollout plan aims to cover 55 high-health facilities in 2024, expand to 75 additional facilities by 2025, and reach a total of 250 sites by 2026. Dr. Chirwa expressed enthusiasm about the plan, stating, “The rollout will greatly impact how we approach TB diagnostics among children. Having reviewed the rollout plan, I am excited and look forward to seeing this intervention implemented in my country.”
Results
Phase one activities included national training-of-trainers for 19 people, specialized stool SOS training for 37 laboratory personnel from 26 sites, healthcare workers’ orientation on stool-based testing techniques, site-level mentorship, and procurement of necessary laboratory supplies. The USAID/LEAP Local Advisor also supported the updating of the National TB guidelines and integrating stool based GeneXpert testing into comprehensive TB/HIV training materials, guidelines, and SOPs. Partners such as USAID-funded LON1 and LON2 projects and the Global Fund have shown their commitment to supporting the implementation of the activities outlined in the scale-up plan. TB LON One and Two have already begun supporting activities in 26 sites, while the Global Fund will cover the remaining sites in phase one starting in July 2024.
Conclusion
This innovative approach addresses the challenges of diagnosing TB in children who cannot produce sputum samples, offering a viable alternative that enhances case detection and management. With the comprehensive rollout plan and committed support from various partners, Malawi is set to revolutionize pediatric TB care, ensuring timely and accurate diagnosis for its youngest and most vulnerable population.
