Although over 6500 GeneXpert machines are now available for TB testing in over 100 countries, these systems are often underused because of high cost, restrictive algorithms, inadequate decentralisation, exclusion of the private sector from concessional pricing, and weak implementation of policies.
One potential solution is to expand access to tuberculosis testing, while simultaneously using the GeneXpert platform to test for other diseases of global health importance. Given the high co-prevalence of TB and HIV in many settings, and the need for greater integration of tuberculosis and HIV services, it makes sense to use the GeneXpert technology for HIV viral load testing. The new global 90-90-90 targets for HIV/AIDS require scaled-up HIV-1 viral load testing.
Please see the attached study from Manipal University, India, where the GX system, already in use for TB, was leveraged for HIV VL testing. The data show that the results of the Xpert HIV-1 Viral Load assay correlated highly with the current reference standard and therefore could be considered for wider use in India by using the large installed base of GeneXpert systems in the TB programme. However, subsidised pricing, similar to that of the Xpert MTB/RIF cartridge, will be essential for scaled-up use in India and other LMICs.
Free access: http://www.sciencedirect.com/science/article/pii/S2214109X17302474