The GeneXpert has been placed in all 9 of South Africa’s provinces under the umbrella of the NHLS in selected TB microscopy laboratories. To date (August, 2013), the system has been deployed to 100 GeneXpert sites. and the instruments have been interfaced to the NHLS LIS (either DisaLab or TrakCare Lab) including the GeneXpert-48 Infinity located in KwaZulu-Natal. These interfaces allow for centralised reporting of patient results with the data being stored in the central data warehouse (CDW) of the NHLS in Sandringham, Johannesburg.
Surveillance of rifampicin (RIF) resistance, a key drug for treatment of tuberculosis (TB), is important, cumbersome and costly when using culture-based surveys. The Xpert MTB/RIF (GeneXpert), which simultaneously detects the presence of Mycobacterium tuberculosis (MTB) complex and RIF resistance, is WHO endorsed for diagnosis of HIV-associated TB and multidrug-resistant TB.
The interfacing of these instruments not only allows for central management of patient data and results but also allows for real-time monitoring of instrument and site performance as well as MTB prevalence in each of the provinces and districts. The structured interface into the LIS systems also collects meta-data around the various reporting probes cycle threshold (Ct) values which may be useful in monitoring Xpert probe data to detect strain diversity by region and over time.
The GeneXpert instruments communicate over either HL7 or ASTM protocols with the relevant LIS system over the existing network infrastructure present in the laboratories. This bi-directional interface not only allows for the uploading of patient results but also allows the instruments to download test requests for each laboratory.