Stool Xpert MTB/RIF Ultra for TB Diagnosis in Children: Experience from a National Scale-up Programme

Introduction: We describe the programmatic scale-up of stool testing using Xpert MTB/RIF Ultra (Ultra), as recommended by the WHO to improve childhood pulmonary TB (PTB) diagnosis.

Methods: USAID's Alliance for Combating TB in Bangladesh Activity, in collaboration with the National TB Control Programme, is implementing a stool-based diagnostic approach at 51 healthcare facilities in Bangladesh to improve PTB detection. Specimens from children (<15 years) with presumptive TB were tested using 'stool Ultra' with routine TB diagnostics. Physicians confirmed TB diagnosis and provided treatment as per national guidelines.

Results: Between March 2022 and December 2023, 16,429 specimens were tested, 871 (5.3%) were positive, and 642 (73.7%) showed 'trace detected' results. Positivity was significantly higher among females, and children presented with 'only cough ≥2 weeks', 'cough ≥2 weeks + weight loss', or 'fever ≥2 weeks, weight loss, fatigue + contact history'. Positivity was higher among '10-14 years old' children; however, 'trace detected' was highest among '5-9 years', followed by children aged '>2-<5 years' and '0-2 years'.

Conclusions: Testing stools using Ultra provides a more effective way of diagnosing bacteriologically positive PTB in children. However, positivity varies with presenting symptoms/criteria, highlighting the need for careful diagnostic evaluation to ensure optimum use of limited diagnostic resources.