Tuberculosis (TB)

WHO advises on the use of multidisease testing devices for TB, HIV and hepatitis

Geneva, 22 June 2017 – The World Health Organization (WHO) released a new information note on “Considerations for adoption and use of multidisease testing devices in integrated laboratory networks”. The document, jointly prepared by the Global TB Programme and the Department of HIV and Global Hepatitis Programme, provides a strategic overview of key implementation considerations for diagnostic integration using testing devices for tuberculosis (TB), HIV and viral hepatitis.

TB is the top infectious killer worldwide, and the leading cause of death among people with HIV, resulting in 400 000 deaths annually. At the end of 2015, 10.4 million people fell ill with TB; 36.7 million people were living with HIV; 256 million people were living with chronic hepatitis B infection; and 71 million people were living with chronic hepatitis C infection. Coinfection with HIV, TB or hepatitis is common in many populations.

The percentage of people who know their infection status is limited. An estimated 60% of people with HIV have been diagnosed, and only 55% of TB patients had a documented HIV test result in 2015. Moreover, only 59% of the people who fell ill with TB in 2015 were detected and notified. For hepatitis, the situation is acute, with very low access to testing – only 9% of people with chronic hepatitis B infection, and 20% of people with chronic hepatitis C infection, knew their status in 2015.

New laboratory technologies are available or being developed to allow for testing of different conditions using a common platform for disease-specific tests. For instance, a single device can be used to diagnose TB and HIV infection, and quantitatively measure HIV and hepatitis C viral load. GeneXpert machines – initially procured by countries for the detection of TB and rifampicin resistance, following an initial WHO recommendation in December 2010 – were subsequently expanded for use in early infant diagnosis of HIV and viral load testing using relevant cartridges in the same GeneXpert device.

“With the power and adaptability of molecular technologies, we are in an era of great advancement for the rapid diagnosis of many diseases using single platforms,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme. “These platforms offer technical and financial efficiencies to countries in their disease control efforts, while expanding access to care and saving lives.”

"We encourage countries to use multidisease platforms for testing of HIV, TB and hepatitis as much as possible and feasible," said Dr Gottfried Hirnschall, Director of WHO’s Department of HIV and Global Hepatitis Programme. "Multidisease devices can increase system efficiencies and improve access to testing for patients in need. Such devices can also help overcome specific challenges in diagnosis and treatment, such as HIV early infant diagnosis and viral load monitoring for both HIV and hepatitis."

These devices bring new opportunities for collaboration and integration, which can provide significant system efficiencies and cost savings; increase patient access; and ultimately improve quality of care. WHO’s information note is primarily intended for use by national laboratory services and TB, HIV and hepatitis programme managers. It may also be of interest to managers of maternal, newborn and child health programmes, and sexual and reproductive health programmes; international and bilateral agencies; and organizations that provide financial and technical support to relevant national health programmes.