Tuberculosis is tough, especially when it affects children. The Kyrgyz National Tuberculosis Program (NTP) has struggled to manage pediatric TB, because traditional diagnosis involves collecting blood or sputum samples, which can be difficult and uncomfortable for children, making it problematic to detect TB.
In Kyrgyzstan, where drug-resistant TB is widespread, the situation is even more concerning. Only half of the estimated 8,500 annual TB cases are detected, and of those, only 5 percent are in children, when the percent of detectable cases should be at least 10 percent. In 2022, the NTP and the National Reference Laboratory (NRL), in collaboration with the USAID Cure Tuberculosis project, led by JSI, embarked on a groundbreaking journey to close this gap.
They developed a stool test validation protocol based on the World Health Organization recommendations and collected stool alongside other biological samples and tested them at NRL using GeneXpert (GX), a rapid molecular diagnostic test. Stool sample testing improves TB detection in children because it is a non-invasive, more comfortable process, especially for under-five-year-olds, who have trouble providing sputum and blood samples. Of the 240 samples from children tested, 17 confirmed TB cases were identified through GX stool testing, in addition to the traditional sputum culture to validate the stool testing.
Aysalkyn Teshabaeva, the head of the pediatric ward at the National TB Center, emphasized the significance of this new approach. “In short, stool testing is proving to be an easy, convenient, and safe diagnostic method for young children,” said Dr. Teshabaeva. The child-friendly method also enables health care professionals to make informed diagnostic decisions and tailor treatment plans: for the first time, they can confirm presumptive or clinically diagnosed TB cases; identify the specific form of TB; and determine resistance to particular TB drugs.
The success of stool testing did not stop at validation. In 2023, the NTP implemented routine GX stool testing across the country, training Lab technicians from all 29 GeneXpert-equipped laboratories to conduct the method. Over the next six months, these technicians tested 306 stool samples from children under the age of 5, resulting in a 5 percent yield in TB confirmation.
The transformation didn’t end there. Clinical guidelines and protocols for pediatric TB, including new treatment regimens for children and adolescents, were developed and approved. The GX stool test was integrated into the new diagnostic algorithm, and more than 200 TB clinicians and epidemiologists were trained on the guidelines.
This child-friendly diagnostic approach is not only about detecting TB; it also increases cure rates by facilitating early initiation of appropriate treatment. It is a ray of hope for the youngest members of Kyrgyz communities and a significant step towards better patient-centered care.
JSI works globally in 27 countries, mainly across Asia and Africa, to enhance TB service delivery and management systems in high-prevalence areas. Our approach involves strengthening government responses, leveraging existing networks, and involving communities in planning, implementation, and monitoring. Our work focuses on enhancing program quality by upgrading lab infrastructure, developing human resources, improving health information systems, and ensuring the availability of essential medicines, collaborating with national partners to address unique program opportunities and contexts. Learn more about our work: https://www.jsi.com/expertise/tuberculosis/
