Browsing by Author "Nyombi, Abdunoor"

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    Evaluation of Automated Molecular Testing Rollout for Tuberculosis Diagnosis Using Routinely Collected Surveillance Data — Uganda, 2012–2015
    (Morbidity and Mortality Weekly Report, 2017) Scott, Colleen; Walusimbi, Simon; Kirenga, Bruce; Joloba, Moses; Winters, Muttamba; Nyombi, Abdunoor; Odeke, Rosemary; Mwangi, Christine; Birabwa, Estella; Mugabe, Frank; Cavanaugh, J. Sean
    In 2012, Uganda introduced the use of GeneXpert MTB/RIF (Cepheid, Sunnyvale CA), a sensitive, automated, real-time polymerase chain reaction–based platform for tuberculosis (TB) diagnosis, for programmatic use among children, adults with presumptive human immunodeficiency virus (HIV)-associated TB, and symptomatic persons at risk for rifampicin (RIF)-resistant TB. The effect of using the platform’s Xpert MTB/RIF assay on TB care and control was assessed using routinely collected programmatic data; in addition, a retrospective review of district quarterly summaries using abstracted TB register data from purposively selected facilities in the capital city of Kampala was conducted. Case notification rates were calculated and nonparametric statistical methods were used for analysis. No statistically significant differences were observed in case notification rates before and after the Xpert MTB/RIF assay became available, although four of 10 districts demonstrated a statistically significant difference in bacteriologically confirmed TB. Once the GeneXpert MTB/RIF platform is established and refined, a more comprehensive evaluation should be conducted. The Xpert MTB/RIF assay detects genetic sequences of Mycobacterium tuberculosis complex as well as mutations associated with resistance to RIF and provides results in 2 hours. The test is much more sensitive than the conventional diagnostic test (sputum smear microscopy), with a pooled sensitivity among persons living with HIV infection of 80% (1). The World Health Organization recommends use of the Xpert MTB/RIF assay as the initial diagnostic test in adults and children with presumptive HIV-associated TB or multidrug resistant TB (2). It is hoped that the use of a more sensitive diagnostic test will increase case detection and notification; however, an evaluation of the Xpert MTB/RIF assay in Nepal found that use of Xpert MTB/RIF testing was associated with an increase in the proportion of TB diagnoses that were bacteriologically confirmed, but had little impact on overall rate of diagnoses or patient care, which might be the case in locations where clinical diagnosis and empiric TB treatment are common
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    Operationalization of COVID-19 Rapid Diagnosis Using Xpert® Xpress SARS CoV-2 Assay in Resource-Limited Settings: Early Implementation Lessons From Uganda
    (Research Square, 2021) Nsawotebba, Andrew; Ibanda, Ivan; Ssentalo Bagaya, Bernard; Nyombi, Abdunoor; Kagirita, Atek; Tugumisirize, Didas; Mujuni, Dennis; Majwala, Robert Kaos; Ocen, Francis; Kabugo, Joel; Adam, Isa; Wekiya, Enock; Munduku, Benoni; Linda, Lillian; Kalyesubula-Kibuuka, Simon; Okiira, Christopher; Kigozi, Edgar; Ogwok, Patrick; Lutakoome Joloba, Moses; Nabadda, Susan; Ssengooba, Willy
    The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that causes COVID-19 disease is a global challenge. Several countries have adopted testing, isolation, and tracing strategy towards the control of the COVID-19 pandemic, but access to rapid and accurate testing is still a global challenge. The conventional PCR – based assay is the most commonly used test yet it has huge costs, infrastructural, and procurement logistical challenges. The Xpert® Xpress SARS-CoV-2 test is an automated in – vitro diagnostic test for the qualitative detection of nucleic acid from SARS-CoV-2 within a turnaround time of 60 minutes on the widely used GeneXpert Dx Instrument Systems. Here we document the best practices and challenges encountered with the operationalization of Xpert® Xpress SARS-CoV-2 testing in a resource-limited setting. Materials and Methods: The Xpert® Xpress SARS-CoV-2 implementation followed an operational work plan that included; Laboratory COVID-19 policy and planning, situational analysis of the Laboratory network, country Xpert® Xpress SARS-CoV-2 assay verification, and rollout at Mutukula Port Health Laboratory. The Laboratory strategy was based on a set of six objectives; conducting infrastructural modifications, building a strong COVID-19 testing capacity, developing robust Laboratory Quality and Information Management Systems, establishing a Bio-risk management and Bio-banking capacity.