Achieving Health Security and Threat Reduction through Sharing Sequence Data

With the rapid development and broad applications of next-generation sequencing platforms and bioinformatic analytical tools, genomics has become a popular area for biosurveillance and international scientific collaboration. Governments from countries including the United States (US), Canada, Germany, and the United Kingdom have leveraged these advancements to support international cooperative programs that aim to reduce biological threats and build scientific capacity worldwide. A recent conference panel addressed the impacts of the enhancement of genomic sequencing capabilities through three major US bioengagement programs on international scientific engagement and biosecurity risk reduction. The panel contrasted the risks and benefits of supporting the enhancement of genomic sequencing capabilities through international scientific engagement to achieve biological threat reduction and global health security. The lower costs and new bioinformatic tools available have led to the greater application of sequencing to biosurveillance. Strengthening sequencing capabilities globally for the diagnosis and detection of infectious diseases through mutual collaborations has a high return on investment for increasing global health security. International collaborations based on genomics and shared sequence data can build and leverage scientific networks and improve the timeliness and accuracy of disease surveillance reporting needed to identify and mitigate infectious disease outbreaks and comply with international norms. Further efforts to promote scientific transparency within international collaboration will improve trust, reduce threats, and promote global health security

Effects of Introducing Xpert MTB/RIF on Diagnosis and Treatment of Drug-Resistant Tuberculosis Patients in Indonesia: A Pre-Post Intervention Study

<div><p>Background</p><p>In March 2012, the Xpert MTB/RIF assay (Xpert) was introduced in three provincial public hospitals in Indonesia as a novel diagnostic to detect tuberculosis and rifampicin resistance among high risk individuals.</p><p>Objective</p><p>This study assessed the effects of using Xpert in place of conventional solid and liquid culture and drug-susceptibility testing on case detection rates, treatment initiation rates, and health system delays among drug-resistant tuberculosis (TB) patients.</p><p>Methods</p><p>Cohort data on registration, test results and treatment initiation were collected from routine presumptive patient registers one year before and one year after Xpert was introduced. Proportions of case detection and treatment initiation were compared using the Pearson Chi square test and median time delays using the Mood’s Median test.</p><p>Results</p><p>A total of 975 individuals at risk of drug-resistant TB were registered in the pre-intervention year and 1,442 in the post-intervention year. After Xpert introduction, TB positivity rate increased by 15%, while rifampicin resistance rate reduced by 23% among TB positive cases and by 9% among all tested. Second-line TB treatment initiation rate among rifampicin resistant patients increased by 19%. Time from client registration to diagnosis was reduced by 74 days to a median of a single day (IQR 0–4) and time from diagnosis to treatment start was reduced by 27 days to a median of 15 days (IQR 7–51). All findings were significant with p<0.001.</p><p>Conclusion</p><p>Compared to solid and liquid culture and drug-susceptibility testing, Xpert detected more TB and less rifampicin resistance, increased second-line treatment initiation rates and shortened time to diagnosis and treatment. This test holds promise to improve rapid case finding and management of drug-resistant TB patients in Indonesia.</p></div

Diagnosis and treatment of individuals at risk of multidrug-resistant pulmonary TB at three provincial hospitals in Java, Indonesia.

<p>The flowchart shows the number of tested, detected and treated individuals in two cohort years. From March 2011 to Feb 2012 (Year 1), individuals were tested with conventional culture and drug-susceptibility testing. From March 2012 to February 2013 (Year 2), individuals were tested with culture and drug-susceptibility testing or Xpert MTB/RIF. <i>Abbreviations</i>: <i>TB</i>, <i>tuberculosis; DST</i>, <i>drug-susceptibility testing; RIF</i>, <i>rifampicin; MDR-TB</i>, <i>multidrug-resistant TB; N</i>, <i>number</i>.</p

Addressing the challenges of implementing evidence-based prioritisation in global health

Global health requires evidence-based approaches to improve health and decrease inequalities. In a roundtable discussion between health practitioners, funders, academics and policy-makers, we recognised key areas for improvement to deliver better-informed, sustainable and equitable global health practices. These focus on considering information-sharing mechanisms and developing evidence-based frameworks that take an adaptive function-based approach, grounded in the ability to perform and respond to prioritised needs. Increasing social engagement as well as sector and participant diversity in whole-of-society decision-making, and collaborating with and optimising on hyperlocal and global regional entities, will improve prioritisation of global health capabilities. Since the skills required to navigate drivers of pandemics, and the challenges in prioritising, capacity building and response do not sit squarely in the health sector, it is essential to integrate expertise from a broad range of fields to maximise on available knowledge during decision-making and system development. Here, we review the current assessment tools and provide seven discussion points for how improvements to implementation of evidence-based prioritisation can improve global health

Culture and drug-susceptibility testing results following Xpert MTB/RIF testing within the same individuals at risk of multidrug-resistant TB in three provincial hospitals in Java, Indonesia.

<p><i>Abbreviations</i>: <i>DST</i>, <i>drug-susceptibility testing; TB</i>, <i>tuberculosis; RIF</i>, <i>rifampicin; NTM</i>, <i>non-tuberculosis mycobacteria</i>.</p><p>Culture and drug-susceptibility testing results following Xpert MTB/RIF testing within the same individuals at risk of multidrug-resistant TB in three provincial hospitals in Java, Indonesia.</p

Time to diagnosis and treatment of rifampicin-resistant TB patients in three provincial hospitals in Java, Indonesia.

<p>These figures show Kaplan Meier time-to-event graphs of health system delays (a), diagnostic delays (b) and treatment delays (c) for rifampicin resistance TB patients detected with culture drug-susceptibility testing from March 2011 to February 2012 and Xpert MTB/RIF from March 2012 to February 2013. <i>Abbreviations</i>: <i>TB</i>, <i>tuberculosis; DST</i>, <i>drug-susceptibility testing; RIF</i>, <i>rifampicin</i>.</p

Follow-on culture results among individuals from various risk groups that tested Xpert MTB/RIF TB positive in three provincial hospitals in Java, Indonesia.

<p><i>Abbreviations</i>: <i>Xpert</i>, <i>Xpert MTB/RIF assay; TB</i>, <i>tuberculosis; NTM</i>, <i>non-tuberculosis mycobacteria; HIV</i>, <i>human immunodeficiency virus</i>.</p><p>Follow-on culture results among individuals from various risk groups that tested Xpert MTB/RIF TB positive in three provincial hospitals in Java, Indonesia.</p