Pacific Family Health Journal with Dr Rodney Itaki
Genexpert TB Test: How Innovative Thinking Changed TB Gland Testing for TB Patients in Papua New Guinea.
“TB can mimic anything”, a senior doctor told me when I was fresh out of medical school and doing my residency program at the Port Moresby General Hospital (PMGH). That phrase stuck with me and I have used the principle to search for TB infection in patients that I consult.
When I started teaching at the UPNG School of Medicine and Health Sciences in 2013 I started looking around for ideas to build my research portfolio. One of the things that any newbie in the academic field will experience is not knowing where to start or begin looking for inspiration or ideas to start their research career. So I was going through that phase of academic career kick starting. I started talking to a few senior lecturers and senior doctors at PMGH to have a feel of where research needs were.
Dr Francis Bannick, a senior Pathologist at PMGH, who later became my research supervisor, told me, “We have this new machine called Genexpert that does TB testing. Why don’t we get needle biopsies from patients with suspected TB of the gland and test for TB using Genexpert. This kind of work has not been done in PNG and if this works, the results of the research will change how we test for TB of the gland in PNG”. I left the room feeling excited and energized to start on this journey of discovery.
I spent the next 4 months searching medical databases and medical journals for similar research done around the world. The amount of research articles published in medical journals ran into the thousands. “This is too much to read” I began to think and the sheer amount of material I had to read was depressing. So I narrowed my reading down to very specific terms – focusing on research done on TB gland testing done using Genexpert in countries where TB infection rates are very high. Most of this kind of research was done in Africa and India so I narrowed my reading to these areas.
Genexpert testing for TB works by looking for pieces of TB DNA in samples (e.g sputum, urine, saliva etc) and makes thousands of copies of these pieces of DNA. It is like looking for TB footprints. The test is positive if TB DNA is found. In addition Genexpert looks for TB DNA that indicates drug resistance. Genexpert is now used worldwide to combat normal TB and drug resistant TB. We now have Genexpert in more than 20 health facilities in PNG that are being used to diagnose and treat multi-drug resistant TB.
When I started out in my research the Genexpert machine at PMGH was housed within the Central Public Health Laboratory (CPHL) where all the TB testing is done so I met with Dr Evelyn Lavu, the Director of CPHL and discussed with her my research idea. She liked it and was willing to be my co-supervisor. Dr Lavu is well respected within the medical field and research in PNG so I felt that what we are planning to do will impact TB gland testing in PNG and improve TB testing and treatment for patients with TB in PNG.
Next week I will continue my story on how we changed TB gland testing in PNG using DNA technology.
Dr Rodney Itaki, MBBS, BMedSci
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