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The Liverpool School of Tropical Medicine is to use Lanner’s Witness simulation software to model the patient and health system outcomes in Tanzania of Genexpert, a system that speeds up TB diagnosis.

A five-year USAID-funded initiative led by the International Union Against Tuberculosis and Lung Disease, entitled Treat TB, was launched in 2008.

As part of the programme, Witness will be used to model the operational rollout of Genexpert in Tanzania in order to better understand the processes involved and map resource requirements against patient and health system costs.

The findings will be published, providing scientific data from which national policymakers and organisations such as the World Health Organization (WHO) can draw recommendations for the use of the technology.

Currently, the most widely used TB test, smear microscopy, is 125 years old and routinely misses half of all cases, according to studies.

A key factor influencing the spread of the disease in some countries is the rise in the number of drug-resistant strains, which are not routinely tested for unless an initial course of antibiotics fails.

Typically, this process takes a number of weeks, but studies have shown that Genexpert MTB/RIF not only detects the presence of TB, but also whether it is resistant to one of the most important drugs in standard TB treatment – Rifampicin.

This diagnosis will have a significant impact on reducing the time for drug-resistant patients to receive appropriate treatment.

Expediting diagnosis is critical in stemming the spread of all forms of TB, as, according to the WHO, if left undetected, a patient will typically infect 10-15 other people in a year.

However, according to the company, while the potential of the technology is dramatic, it is expensive.

A four-module Genexpert machine is likely to cost around USD17,000 (GBP10,400) for developing countries, and per test the costs are around USD14 to USD17.

‘Witness will help to identify the most cost-efficient and effective way of implementing Genexpert to ensure every penny spent is utilised to the end goal: reducing the spread of the disease and saving the maximum number of lives possible, particularly among the poor where TB is most prevalent,’ said Ivor Langley, operational research analyst at the Liverpool School of Tropical Medicine.

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