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National Tuberculosis Control Programme Sputum transport and TB drug-resistant Survey

National Tuberculosis Control Programme Sputum transport and TB drug-resistant Survey

Project Lead(s)
Project Background 

Tuberculosis is a disease of antiquity but still a global health challenge. It had always been the leading cause of death by a single infectious disease till the emergence of COVID-19. The emergence and rapid rise in the number of drug-resistant TB cases in Ghana is a huge threat to the Ghanaian health system, this has led the NTP in collaboration with partners such as NMIMR to embark on this active case search in Out-patient departments in hospitals to trace, test and treat TB in its early stages to reduce morbidity and mortality.

Since TB treatment is individualized, we follow-up on patients throughout all 6 to 24 months in the cases of drug-resistant TB, conducting various tests to determine whether or not drug therapy is successful or fails.

Objectives/Research Areas 
  • Rapid case diagnosis using Sputum Transport System
  • Relapse/recurring cases
  • Multidrug monitoring
  • TB/COVID diagnosis
  • Periodic community outreach/engagement activities in endemic communities

As part of our objectives to diagnose rapid TB cases, we employ the use of the GeneXpert machine, a Real-time PCR system that mainly targets the insertion sequence IS6110 and the rpoB gene of the Mycobacterium tuberculosis to determine a positive or a negative test. Determination of the rpoB gene allows this system to also detect any mutations in this gene and therefore determines the resistance to rifampicin, one of the most potent anti-tubercular medications. Results are churned out in about two hours helping to rapidly test and treat positive patients to reduce the incidences of community spread of TB.

NMIMR-Bacteriology also helps the NTP in MDR and DR monitoring of patients. We conduct tests such as the line probe assay, a reverse hybridization technique that can detect Mycobacterium tuberculosis as well as resistances to the two most potent TB drugs – isoniazid and rifampicin. Results from this test inform drug administration to patients. Drug-resistant patients (MDR, Rif-mono, INH-mono, Polyresistant, Pre-XDR, XDR) are followed up through monthly culture of their sputum to determine if the drug regimen is working. If the drug therapy is working confluent growth is not detected upon culture in Lowenstein-Jensen media after 12 weeks.

As part of NMIMR’s mandate to train postgraduate students in biomedical sciences and support the public health programmes of the Ministry of Health and Ghana Health Service, we have conducted several pieces of training for scientists from Ghana and within the West African sub-region. Yearly, young and enthusiastic scientists from countries such as the Gambia, Nigeria, Liberia, Senegal, Burkina Faso among others are trained on the techniques used in TB monitoring we use in our labs. These scientists are given hands-on training and this expert knowledge acquired are taken back to their various countries to impact TB treatments in their countries.

Several pieces of training on smear preparation, staining, microscopy and the use of the GeneXpert machine have been conducted over the years, this led to the development of a standardized lab TB Microscopy manual (First edition. 2001)which directs lab personnel on the proper and safe ways to conduct these tests. The PI, Prof. Yeboah-Manu is a lead author.

We have also conducted several outreach programmes to spread awareness of the disease making it known that TB is a curable disease and early detection leads to fewer morbidity and mortality cases. As part of NMIMR’s 40th anniversary, the bacteriology department conducted a screening exercise in Gomoa Onyaadze on the 23rd of October 2019, in the Central Region. In March 2021, as part of the World TB Day celebrations, NMIMR and the NTP embarked on a sensitizing outreach in the Agbogbloshie and Korle-Bu communities on TB as well as screening and testing of suspected TB patients upon several questioning.

With regards to bidirectional testing of COVID-19 and TB, the NMIMR and NTP in 2020 conducted a survey to determine coinfection of TB and COVID-19 in COVID-19 suspected individuals. Results showed that the diseases overlap in symptoms and clinical presentations with some suspected COVID-19 patients testing positive for TB only and others having a coinfection of both diseases. This buttresses the need for differential diagnosis of other respiratory tract infections in suspected COVID-19 patients in TB endemic regions such as Ghana. A manuscript has been published in this light.

Key Findings 
  • Detection of XDR, pre-XDR, multiple MDR and Polyresistant cases in the Ghanaian communities
  • Active case search through the trace, test and treat policy has yielded great results. All positive cases detected through this policy would have been missed and increased the likelihood of community spread of the disease.
  • The need for differential diagnosis of TB and COVID-19 in suspected COVID-19 patients in TB endemic countries such as Ghana.
Ongoing Activities  
  • Writing of manuscripts – Continuous testing to eradicate active community spread of the disease.
  • Drug profiling all positive cases for effective drug therapy
  • Monitoring of drug-resistant cases for proper disease outcomes and reduction in mortality rates.
Key Publications  

Afum T, Asare P, Asante-Poku A, Darko-Otchere I, Morgan PA, Bedeley E, Asandem DA, Musah AB, Siam IM, Tetteh P, Adusi-Poku Y, Frimpong-Manso R, Bonney JHK, Ampofo W, Yeboah-Manu D. Diagnosis of tuberculosis among COVID-19 suspected cases in Ghana. PLoS One. 2021 Dec 28;16(12):e0261849. doi: 10.1371/journal.pone.0261849. PMID: 34962960; PMCID: PMC8714104.

Osei-Wusu S, Amo Omari M, Asante-Poku A, Darko Otchere I, Asare P, Forson A, et al. Second-line anti-tuberculosis drug resistance testing in Ghana identifies the first extensively drug-resistant tuberculosis case. Infection and Drug Resistance. 2018;Volume 11:239-46.

Community Engagement Activities  
An NMIMR personnel taking demographic data from community individuals at Gomoa-Onyaadze in 2019
Community Health nurses and nursing students at the World TB Day outreach at Korle-Bu in 2021
NMIMR personnel in their World TB Day attires preparing to leave NMIMR
The NTP programme Manager sensitizing all present at the World TB Day outreach in March 2021.
Dr. Isaac Okyere - Bacteriology
Senior Research Fellow
Senior Research Fellow
Mr. Basit MAbdul Musah (Research Assistant)
Research Assistant
Mr. Theophilus Afum
Research Assistant
External Collaborator(s) 
Dr. Asiedu Bekoe- Director, Public Health- Ghana Health Service
Dr. Yaw Adusi-Poku – National Tuberculosis Programme Manager
Dr. Mrs. Rita Frimpong-Amenyo– Deputy Programme Manager – NTP
Mr. Felix Sorvor – National Laboratory Focal Person - NTP
The Global fund
Ghana Health Service