Evaluating the Impact of the GeneXpert Technique on Case Detection and Management of Tuberculosis in Ghana

Background: Rapid and more sensitive diagnostic assays have seen substantial investment globally intending to improve Tuberculosis (TB) diagnosis towards treatment. This study evaluated the impact of the GeneXpert intervention on TB case detection and management in Ghana.

Methods: The study made use of an interrupted time series design. Data from Ghana’s District Health Information Management System (DHIMS II) was used to evaluate the impact of the intervention. A cross-section of DHIMS II data was analyzed repeatedly using 2017 and 2022 as baseline and end lines, respectively. Descriptive analysis and interrupted time series models were used.

Results: No immediate impact was observed on bacteriologically confirmed TB, however, 5 years following the intervention, the number of bacteriologically confirmed TB cases increased by an average of 562 cases per year (step and ramp (coefficients of pre- and post-intervention ) variables being -278.5 (95% (CI): -1118.3, 561.3) and 561.9 (95% CI: 352.3, 771.6), respectively. The cure rate decreased on average by 32.8% at the onset (step coefficient of -32.8 (95% CI: 40.5 – 25.0), however, there were no significant changes in the pre-and post-intervention cure rates (ramp coefficient = 1.5 (95% CI: -4.0, 7.0). Subsequently, the treatment completed rate increased sharply in the year of implementation but did not significantly differ from the pre-and post-intervention period (step and ramp coefficients were 29.4% (95% CI: 27.0, 31.9) and 1.5% (95% CI: -1.8, 0.4). Moreover, the intervention did not have a significant sudden or gradual impact on adverse treatment outcomes; step and ramp coefficients were 3.0% (95% CI: -4.5, 10.6) and 0.2% (95% CI: -5.1, 5.5)

Conclusions: While bacteriologically diagnosed TB cases improved during the implementation period, clinical outcomes were not significantly impacted. To achieve recommended global targets, there is a need to address treatment follow-up challenges and enhance monitoring as part of addressing implementation challenges.