June 2009

17th Union Africa Region - Abstracts

From Evidence to Policy and Implementation of New TB Diagnostics

Moses Joloba*, Heidi Albert
National Tuberculosis Reference Laboratory (NTRL), Kampala, Uganda* and FIND - Uganda

Uganda has an estimated incidence of 355 TB cases per 100,000 (WHO Global Report, 2008). In 1997, 0.5% of new TB cases and 4.4% of re-treatment cases were reported as MDR-TB. Recent studies have suggested higher rates of 13-15% among re-treatment cases. Smear microscopy is the mainstay of TB diagnosis, with only 2 laboratories performing culture and drug susceptibility testing. The national TB laboratory network has implemented a quality assurance programme for ZN microscopy, which covers about 80% of laboratories. This will form a strong basis on which to build increased diagnostic capacity at regional centres, and to implement standardized training, technical support and quality assurance for culture and molecular techniques.

FIND has established a TB diagnostics research laboratory within the NTRL, whose objectives include evaluation and demonstration of new diagnostics and supporting the National TB and Leprosy Programme in technology transfer and implementation of new WHO-approved diagnostic technologies. FIND and NTRL have collaborated to date on studies including evaluation of LED-based fluorescence microscopy methods, and local validation of line probe assays for rapid detection of multidrug-resistant TB. Local validation of liquid culture in the diagnosis of smear-negative TB is also underway. These data will be used to inform the development of national guidelines for TB diagnostics.
 

Working towards integration of TB and HIV laboratories in Ethiopia

Mulualem Agonafir*, Narang R, Almaz Abebe*, Balasangameshwara VH, Paramasivan CN, Somoskovi A, Roscigno G
EHNRI* and FIND

Presenting Author: Mulualem Agonafir, TB team leader, National Tuberculosis Reference Laboratory, EHNRI, Addis Ababa.
The Maputo Declaration calls for a well-organized integrated laboratory system that supports infectious diseases like TB, HIV, Malaria and Opportunistic Infections (OIs) commonly found in low-income countries. The Ethiopian Health and Nutrition Research Institute (EHNRI) has developed a Master Plan for the Public Health Laboratory Program in 2005 and the 2nd version for integrated laboratory services was published in 2008. This plan encompasses all components of an adequate laboratory system including training; infrastructure upgrade and maintenance; quality assurance; logistics and commodity management; and linked referral services as well as timely reporting.

The presentation will provide examples of the activities involved in the above components of diagnostic services:

  1. Training: Integrated laboratory training on HIV and TB at ACILT-accredited courses in Johannesburg and Addis.
  2. Infrastructure: Establishment of central and regional laboratories with dual HIV-TB testing capacity.
  3. Quality Assurance: Establishment of integrated national QA office at EHNRI.
  4. Logistics and Equipment: Harmonizing of UNITAID/FIND/WHO support for TB detection and drug susceptibility testing and CDC/PEPFAR support for HIV testing.
  5. Referral linkage: Integrated specimen transport system for HIV/TB/Malaria/OIs; reduction of turn around time.