Bottlenecks and recommendations for the incorporation of new technologies in the tuberculosis laboratory network in Brazil (original) (raw)
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Experience establishing tuberculosis laboratory capacity in a developing country setting
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2010
To describe the experience of strengthening laboratory diagnosis of tuberculosis (TB) in a resource-limited country with high TB-HIV (human immunodeficiency virus) and multidrug-resistant TB (MDR-TB) prevalence. In the Kingdom of Lesotho, which is confronted with high levels of TB, MDR-TB and HIV prevalence, between 2006 and 2008 a coalition of the Foundation for Innovative New Diagnostics, Partners In Health and the World Health Organization renovated the National TB Reference Laboratory and reinforced microscopy services, streamlined conventional culture and drug susceptibility testing (DST) and introduced modern TB diagnostic methods. It was feasible to establish a biosafety level three facility for solid culture and DST and an external quality assessment programme for smear microscopy within 4 months, all in 2007. Liquid culture and DST were introduced a month later. Preliminary results were comparable to those found in laboratories in industrialised countries. A year later, lin...
BMC health services research, 2015
This article presents the qualitative component linked to a larger study of implementation of the Xpert™ MTB/Rif technology in two Brazilian cities. Despite intrinsic advantages of new health technologies, its introduction can be disruptive to existing routines, and it is thus important to understand how these innovations are perceived by the different groups involved in its regular use. This study was based on semi-structured interviews with patients, lab technicians, health care workers and managers involved with diagnosis and care of Tuberculosis (TB). The interviews had their content analyzed in order to abstract the different perspectives for the various actors. For patients the changes were not perceived as significant, since their greatest concerns were related to treatment and the stigma associated with TB. The professionals in general welcomed the new technique, which dramatically decreases the workload, time and reliability of diagnosis, in their view. However, we noted di...
Eurosurveillance
National reference laboratories (NRL) and other laboratories are the cornerstones of well-functioning tuberculosis programmes and surveillance activities. However, the scope and activity of NRL services for mycobacterial identification and drug susceptibility testing (DST) has not been examined in detail across the European Union (EU), nor has the added value of cooperation and networking at the European level been explored with regard to strengthening laboratory services. Therefore, the European Centre for Disease Prevention and Control (ECDC) has commissioned a survey to explore these issues and to identify areas of work that could bring added value by supporting networking activities of tuberculosis (TB) reference laboratories in the EU. Structured questionnaires were sent to TB reference laboratory experts in the EU and European Economic Area (EEA) countries, and in three additional countries selected on the basis of their networking activities with EU projects and other initiat...
Frontiers in microbiology, 2017
At a global level, with the increase in healthcare costs, there is a need to assess the economic impact of the incorporation of new technologies in different health disorders in different countries. There is scarce information regarding costs incurred with the use of current or new diagnostic tests for tuberculosis or from the vantage point of their incorporation within the healthcare systems of high-burden countries. The present study aimed to assess the mean cost and the activity based cost of the laboratory diagnosis for tuberculosis by means of conventional techniques and from the Detect TB(®)LabTest molecular test kit in a general high-complexity hospital of the public health system in Brazil. Cost analysis was performed by means of primary data, collected in the Mycobacteria and Molecular Biology Laboratory in 2013. The mean cost and activity based cost were, respectively, U$10.06/U$5.61 for centrifuged bacilloscopy by Ziehl Neelsen (ZN) and Auramine (AU); U$7.42/U$4.15 for di...
2020
Laboratory plays a critical role in tuberculosis (TB) control by providing testing for diagnosis, treatment monitoring, and surveillance at each level of the health care system. Weak accessibility to TB diagnosis services still represents a big concern in many limited resources' countries. Here we review the experience of Burkina Faso in implementing a comprehensive intervention packages to strengthen TB laboratory capacity and diagnostic accessibility. Methods Interventions lasted from October 2016 to December 2018 and focused on two main areas: i) development of strategic documents and policies; ii) implementation of TB diagnostic technology. National TB laboratory data were collected over 2016-2018, stratified according to five programmatic TB laboratory indicators: i) Percentage of notified new and relapse TB cases with bacteriological confirmation; ii) Percentage of notified new and relapse TB cases tested with a WHOrecommended rapid diagnostic test (WRD); iii) Percentage of notified, bacteriologically confirmed TB cases with DST results for rifampin; iv) Percentage of notified MDR-TB cases; v) Smear/Xpert ratio. We evaluated the following indicators between 2016-2017 and 2016-2018 Results From 2016 to 2018 the number of bacteriologically confirmed cases increased of 4%. The number of new and relapse TB cases notified tested with a WRD increase of 27% compared to 2016 and the number of bacteriologically confirmed cases with an available DST result for rifampicin increased from 27% of 2016 to 66% in 2018. The number of MDR-TB cases notified over the number of estimated MDR-TB cases in 2018 increase of 35% compared to 2016. In 2018, the ratio between the number of smear microscopy and Xpert MTB/RIF test decreased from 53 in 2016 to 21 to 2018. Conclusion We demonstrated that implementation of comprehensive package of laboratory strengthening interventions had a positive effect on the evaluated indicators and external assistance has played a fundamental role in speeding up the TB laboratory system improvement process
Scale-up of Multidrug-Resistant Tuberculosis Laboratory Services, Peru
Emerging Infectious Diseases, 2008
Over the past 10 years, the Peruvian National Tuberculosis (TB) Program, the National Reference Laboratory (NRL), Socios en Salud, and US partners have worked to strengthen the national TB laboratory network to support treatment of multidrug-resistant TB. We review key lessons of this experience. The preparation phase involved establishing criteria for drug susceptibility testing (DST), selecting appropriate DST methods, projecting the quantity of DST and culture to ensure adequate supplies, creating biosafe laboratory facilities for DST, training laboratory personnel on methods, and validating DST methods at the NRL. Implementation involved training providers on DST indications, validating conventional and rapid fi rst-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting. Monitoring included ongoing quality control and quality assurance procedures. Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation. Operational research guided laboratory scaleup and identifi ed barriers to effective capacity building.
The Lancet, 2010
The Millennium Development Goal target for tuberculosis control is to halt the spread of tuberculosis by 2015, and begin to reverse the worldwide incidence. After the introduction of standard control practices in 1995, 36 million people were cured and about 6 million deaths were averted. However, substantial scientifi c advances and innovative solutions are urgently needed together with creative new strategies. Strong international and national political commitment is essential. Urgent action is needed by national governments to fund their own programmes, and for the G8 countries and other donor governments and organisations to support governmental and non-governmental eff orts. To foster the global need for urgent action to control the tuberculosis epidemic, The Lancet, in collaboration with the Stop TB Partnership, WHO, Global Fund to Fight AIDS, Tuberculosis and Malaria, and the experts participating in this Series, is launching The Lancet TB Observatory, which will assess and monitor progress in tuberculosis control and research, assess domestic and global fi nancing, regularly disseminate information, and advocate for intensifi ed eff orts with stakeholders at all levels.