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

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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.

Keywords: PLHIV; SOS stool; TB diagnosis; childhood TB; pulmonary TB

Document Type: Research Article

Affiliations: 1: KNCV Tuberculosis Foundation, The Hague, The Netherlands 2: National Tuberculosis Program Vietnam & National Lung Hospital, Hanoi, Vietnam 3: KNCV Tuberculosis Foundation, Hanoi, Vietnam 4: Vietnam National University of Medicine and Pharmacy, Hanoi, Vietnam 5: Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam

Publication date: January 1, 2023

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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