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Objective: To investigate any gains made in Tuberculosis (TB) case detection during Genexpert MTB/Rif universal access to Drug Susceptibility Testing (DST) Algorithm roll out in Manicaland Zimbabwe, 2017 to 2018. Design: Retrospective study design. Setting: The study setting was the eastern province in Zimbabwe called Manicaland which has 304 health facilities served by 15 Genexpert testing sites. Participants: Total of 36 056 Mycobacterium Tuberculosis (MTB) results generated from 15 Genexpert sites were enrolled. Interventions: The intervention was the universal access Genexpert MTB/Rif algorithm rollout. Early TB detection occurs with Genexpert MTB/Rif because it has lower limit of detection compared to less superior smear microscopy, which was replaced as roll out occurred. Main Outcome Measures: Semi quantitative MTB/Rif test results and the rifampicin resistance pattern. Results: The study revealed that 5769/36056 (16%) were analysed using targeted MTB diagnostic algorithm versus 30286/36056 (83.7%) analysed using universal access to Drug Susceptibility Testing (DST) MTB diagnostic algorithm. Among the positives the percentage positivity contributed by the semi quantitative measure of between MTB detected trace and MTB detected low was 1043 out of 2222(46.9%), suggesting early TB detection. There was a statistically significant increase in Rifampicin (RR) detection. Conclusion: As roll out occurred more tests were analysed using the superior diagnostic tool Genexpert MTB/Rif, thus addressing early TB detection. There was statistically significant more rifampicin resistance detected during roll out.

Objectives: The aim of this study was to carry out a comparative analysis using Genexpert MTB/Rif Ultra (Ultra) on clinical samples of frozen sputum previously analyzed on Genexpert MTB/Rif version 4 (Xpert)and Mycobacterium Growth Indicator Tube (MGIT) culture.Design: The study employed both retrospective and prospective cross sectional design.Setting: Mutare Provincial Hospital Manicaland, Zimbabwe.Subjects: One hundred and nine de-identified frozen sputum.Interventions: Ultra test.Main Outcome Measures: Ultra results.Results: There was 96/109 (88%) concordance and 10/109 (9.2%) discordance between Xpert and Ultra. Sputum frozen for 7 years then analyzed on Ultra performed better than 7 years previously when it was analyzed as raw sputum on Xpert using MGIT as gold standard (95.6% and 93.2% respectively).The results were comparable and statistically significant, kappa analysis between Xpert and frozen sputum Ultra was not statistically significant showing a slight level of agreement of 0.147 (p value =0.079), 95% CI (-0.1078, 0.4018).Conclusion: Results of Ultra on frozen sputum correlate reasonably well. The study findings show that TB positive frozen sputum from presumptive DRTB, run on Ultra after 7 years freezing can perform better than previously run Xpert results compared to MGIT as gold standard. In light of the research findings, potential implication are that to save on cost, comparison of performance of newly diagnosed tests can be done using frozen sputum, pre run on panel of TB tests.