P035

1:KNCV TB foundation; 2:African Society Laboratory Medicine (ASLM)

Stool-based testing, recommended by the WHO to diagnose TB in children, has been shown to increase TB notification and access to diagnosis. In addition, it showed to benefit adults experiencing difficulties in expectorating sputum. While currently being recommended for the GeneXpert platform only, proof of concept was provided for stool-based testing using the simple one step stool (SOS) method on Xpert-MTB/XDR and the Truenat platform.

To get insights in the extent to which stool-based testing is implemented in Africa we conducted an online survey including representatives of 47/54 African countries. Here, we report the results of this survey.

We received responses for 35 (74%) countries. In 25 (71%), implementation of stool-based testing has started with 11 countries piloting this, and 14 countries engaged in nationwide implementation, while planning the start of stool-based testing is ongoing in 5 more countries. Of 25 countries, in 15, key populations beyond children are included (most often adolescents (n=11), and adults who cannot spontaneously produce sputum (n=10)). In 7 countries (all implementing stool testing nationwide), the Truenat platform was (also) used, while in 9 countries piloting, and in 11 countries with nationwide implementation, the XpertMTB/XDR test was used on stool.

Stool-based testing is widely implemented in the African region and countries do include populations and test (platforms) beyond the WHO-recommendations. Guidance on stool processing methodology for the different assays are developed, so that a bacteriologically confirmed diagnosis including the possibility to obtain a resistance profile becomes in reach for those who cannot easily expectorate sputum.