PPMD (Public-Private Mix DOTS)
- DOT-Free TB medications for Philhealth members and Philhealth beneficiaries and socialized fee for non-Philhealth members.
- Health Education and provider Initiated Counselling and Testing (PICT) for all enrolled patients.
- PPD and DSSM as part of TB screening
PMDT (Programmative Management of Multi-drug Resistant TB)
- Screening of drug resistant TB cases using the GeneXpert machine
- Treatment of DRTB cases for free
- Hospitalization packages for MDRTB patients undergoing treatment
- PICT for all enrolled patients
- Contact tracing for all contacts of the MDRTB index patients
- Use of MTB/Rif GeneXpert machine for screening of presumptive DRTB patients.
- Drug Susceptibility Test (DST) for first line anti-TB drugs
- TB DSSM and TB Culture for screening, diagnoses and monitoring purposes
- HIV testing for enrolled DSTB and DRTB patients
THE GENE EXPERT TEST
Genexpert Test – TB diagnosis and resistance Testing
The Genexpert test is a molecular test for TB which diagnoses TB by detecting the presence of TB bacteria, as well as testing for resistance to the drug Rifampicin.
How does the Genexpert test work?
The test is a molecular test which detects the DNA in TB bacteria. It uses a sputum sample and can give a result in less than 2 hours. it can also detect the genetic mutations associated with resistance to the drug Rifampicin.
Who developed the Genexpert test?
The Genexpert has been developed by the Foundation for Innovative New Diagnostics (FIND), who have partnered with the Cepheid corporation and the University of Medicine and Dentistry of New Jersey. Some of the funding for the development of the Genexpert was provided by the NIH.
The use of the Genexpert test
WHO recommended that the test should be used as the initial diagnosis test in individuals suspected of having MDR TB, or HIV associated TB. They also suggested that it could be used as a follow on test to microscopy in settings where MDR TB and/or HIV is of lesser concern, especially in smear negative specimens, because of the lack of accuracy of smear microscopy. They did however say that they recognised the major resource implications of using it in this second way.
WHO did also emphasize that the test does not eliminate the need for conventional microscopy culture and drug sensitivity testing, as these are still required to monitor treatment progress and to detect other types of drug resistance. The Genexpert MTB/RIF cannot be used for treatment monitoring, as it detects both live and dead bacteria.
Further guidance was subsequently provided by WHO on the rapid implementation of the new test.
Advantages of the test
WHO have been particularly keen on the use of the test and in 2010 said that:
“This new test represents a major milestone for global TB diagnosis and care. It also represents new hope for the millions of people who are at the highest risk of TB and drug resistant disease.”
Dr Mario Ravihlione, Director of WHO Stop TB Department
The main advantages of the test are, for diagnosis, reliability when compared to sputum microscopy and the speed of getting the result when compared with the culture test. For diagnosis of TB, although sputum microscopy is both quick and cheap, it is often unreliable. It is particularly unreliable when people are HIV positive. Although culture gives a definitive diagnosis, to get the result usually takes weeks rather than the hours of the Genexpert test.
The main advantage in respect of identifying rifampicin resistance, is again the matter of speed. Normally to get any drug resistance result takes weeks rather than hours.
What is the cost of the Genexpert TB test?
At De La Salle Medical and Health Sciences Institute – Center for TB Research the Genexpert Test is available for PhP5,000.
Patients availing the offer under the NTP program like Retreatment cases (previously treated with TB), People living with HIV, vulnerable population (Children below 15 years old, Inmate, Senior Citizen above 60 years old, Immuno- compromised) will be scheduled for availability and the Genexpert test is done for free.
What is the Schedule of the Genexpert TB test?
Monday – Thursday at 8 am – 10 am for scheduled patients without pay
Monday – Saturday at 8 am – 10 am for patients who will pay fee of PhP 5,000
When is the release of the Genexpert TB test result?
Usually the patients will get their Genexpert result within a day. But under certain unforeseen circumstances the patients will be informed if there will be a delay in 1 – 3 days.