Rolling out faster TB diagnostics in high endemic countries
In a joint collaborative effort between partners, GLI, GDF and FIND initiated the EXPANDx-TB project, with support from UNITAID, to introduce newer and faster diagnostics tests for the detection of multidrug-resistant (MDR) TB in 27 high-burden countries. Under this project, FIND as the major implementing partner, is responsible for rolling out these technologies through laboratory strengthening activities and also by improving capacity building and knowledge sharing. To facilitate these aims, FIND is holding comprehensive training workshops whereby participants gain knowledge in the use or best practice of the latest WHO-endorsed technologies.
The quality and training of personnel and adherence to strict operational practices are milestones for the success of these new assays. FIND has developed extensive training courses in both English and French to adequately prepare TB laboratory staff to perform day-to-day, routine, quality assured tests and to interpret results using rigorous laboratory protocols, standard operating procedures and internal quality controls.
One of the innovative tools under the EXPANDx-TB was to introduce line probe assay (LPA), a test that rapidly detects TB and MDR-TB. When integrated into screening algorithms, LPA significantly reduces the demand for conventional culture and drug susceptibility testing (DST) laboratory capacity. The developed LPA training package covers topics on essential biosafety related to molecular testing, assay related instrument operation, calibration and maintenance, molecular laboratory layout and set-up, specimen and reagent preparation, hybridization of amplified products, interpretation of line probe patterns, contamination control and trouble shooting, and quality control of LPA. The standardized training curriculum consists of lectures, demonstrations of the assay and hands-on, practical, one-to-one sessions.
Training sessions on LPA have already been held in the Côte d'Ivoire and Myanmar and their stories are told through the links on the right.
In addition to the UNITAID-funded project, FIND has been involved in introducing a novel LED-based fluorescent microscope developed in partnership with Zeiss. The extroadinary results obtained from the demonstration studies carried out in 27 sites in 9 countries, together with data generated by others, enabled WHO-STAG to endorse fluorescent microscopy as a primary screening method for diagnosing pulmonary TB in 2009. LED fluorescence microscopy detects 10% more TB cases and requires less time to read than conventional microscopy, making it a highly effective tool for rapid low-cost diagnostic method. To facilitate the introduction of this microscope, FIND has developed an exclusive training module based on the ‘Acid-fast Direct Smear Microscopy’ Training Modules developed by WHO-CDC-RIT-IUATLD-APHL in 2004. The modules focus on safety precautions for TB microscopy (including collection and transport of sputum samples from suspected TB patients); smear preparation and fluorescence-based staining methods; preparation of reagents for fluorescence-based AFB microscopy; reading, recording and reporting of fluorescent smears; managing supplies for fluorescence-based AFB microscopy; and quality assuring fluorescence-based AFB microscopy.
As part of FIND's access strategy, the training on iLED was carried out in Haiti in mid-May of this year. Further details can be read via the link on the right.