Alcohol-based conservation of sputum : quantitative and qualitative impact among referred samples from distant centres for Genexpert MTB/Rif analysis

Background and challenges to implementation : Genexpert MTB/Rif technology has been developed to increase TB case detection in low-income and high-burden countries. These countries generally face major problems regarding the transportation of samples from peripheral centers to central labs due to biosafety issues, long distances and high temperatures. These issues could diminish the overall impact of the Genexpert MTB/Rif technology in low income countries. Intervention or response : To facilitate the transport of samples from peripheral health centers to central GeneXpert-equipped labs (TB Reach funding), we validated a protocol of alcohol-based conservation of the samples and implemented it in the South-Kivu Province (DRC). Results and lessons learnt : Sputum conserved by a 1/1 dilution of 95° ethanol can be analyzed by Genexpert even after spending 48h at 37°C. The use of this protocol in the South-Kivu Province permitted a considerable increase in terms of efficiency of the Genexpert technology. Conclusions and key recommendations : A major problem faced by low-income countries is the transportation of samples due to long distances and high temperatures. Alcohol-based conservation of samples permits to overcome bio-hazard, time and bad conservation issues. In addition, the spread of this protocol permits a considerable increase of the impact of the implementation of a Genexpert MTB/Rif machine in the population.