The Lesotho Ministry of Health, FIND and partners establish new TB lab
One of the most urgent health needs for African countries, which have the highest incidence of tuberculosis (TB) in the world, and for sub-Saharan Africa, which is battling the combined effects of TB and HIV/AIDS, is the availability of better diagnostics and the strengthening of existing health services. This includes improved, quality assured and safer laboratory facilities for TB culture and drug susceptibility testing (DST), something which can make a huge difference when it comes to the rapid and accurate diagnosis of TB and its more resistant forms.
Due to the rise in extensively drug-resistant (XDR) TB, which results when the multidrug-resistant (MDR) form caused by bacterial strains becomes resistant to first-line, as well as to the most effective second-line, drugs, the World Health Organization (WHO) in consultation with partners and experts prepared action plans and called upon governments to more effectively address this issue. XDR-TB is essentially untreatable today and the true scale of the problem remains almost unknown because only few countries are equipped to diagnose it.
The Kingdom of Lesotho, with a per capita rank among the worst countries affected by TB, responded rapidly to this call. Growing concerns over the emergence of MDR and XDR-TB in the neighboring South African province of KwaZulu-Natal served as a stimulus to action. In November 2006, following a request from Lesotho’s Ministry of Health and the WHO, FIND visited the country’s National Reference Laboratory (NRL) in Maseru. The evaluation showed that there was an important shortage of qualified personnel, equipment and financial resources.
Furthermore, a quality assurance program for sputum microscopy, guidelines and standardized training for these activities was not in place.
Following this initial study, WHO's STOP TB Department, Partners in Health (PIH), and the Ministry of Health and Social Welfare
invited FIND to help establish a state of the art NRL facility capable of performing quality assured sputum microscopy.
A successful and results-oriented partnership
For this project, FIND’s laboratory strengthening unit designed an action plan and in May 2007 sent a technical consultant to supervise and coordinate the renovation of the laboratory. The aim was to provide the necessary expertise to ensure the introduction of improved microscopy services, to establish a Standard Operating Procedure (SOP) and to provide training. The WHO appointed a medical officer to coordinate MDR-TB treatment activities. PIH played an active role by providing the necessary human, logistics and financial support.
A modern and efficient laboratory
The renovated laboratory was finished in record time (between May and July 2007).
It now has a Biosafety level three (BSL-3), as recommended by the WHO and Centers for Disease Control.
In addition to conventional TB culture activities, automated liquid culture system and speciation by lateral flow assay
have been introduced. This permits laboratory technicians to give results to patients in a few days rather than
the months its takes with the more traditional solid culture method currently being used in most high-burden countries.
Finally, FIND introduced programs to build laboratory capacity for clinical trials and routine use of diagnostic technologies.
Today, the NRL at Maseru successfully meets all the national basic laboratory requirements for:
Quality assured smear microscopy;
Culture and DST on solid egg based medium;
TB culture and drug sensibility testing (DST) using liquid culture;
Speciation by immunochromatographic lateral flow assay.
In addition to the SOP for culture and DST, a standard recording and reporting system has been introduced to monitor
key indicators and the progress towards meeting regional and global targets for TB control.
The inauguration of the renovated NRL was held on 14 November 2007 in Maseru in the presence of Mrs Mathato Mosisili,
First Lady of Lesotho, Dr. M. Ramatlapeng, Lesotho’s Minister of Health and Social Welfare, Dr. Mario Raviglione,
Director of WHO's Stop TB Department, Dr. Giorgio Roscigno, FIND CEO, members from PIH, University Research Council (URC),
senior officials from the MOH SW, and other non-governmental organizations who contributed to make this project possible.
The laboratory will benefit from on-going technical support from FIND.
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