experience establishing tb laboratory capacity in lesotho dr vollepore find

Experience establishing TB Laboratory Experience establishing TB Laboratory capacity in Lesothocapacity in Lesotho

Dr Vollepore

FIND

C.N.P FIND Board presentation 24th Oct.08

FIND ApproachFIND Approach

Based on• Product needs

• Local needs and capacity

• Appropriate level of healthcare system

Collaborative with partners• International partners

• (WHO, GLI, GDF,UNITADAID, CDC, PEPFAR, USAID, Partners in Health, MSF, etc.)

• Local partners

• (National Disease Control Programmes, Government)


Lesotho: Situation analysisLesotho: Situation analysis

• New cases notified - 2007: 12,275

• Estimated prevalence: 544 per 100,000

• Estimated annual incidence : 691 per 100,000

• Estimated incidence of New sm+ cases: 281 per 100,000

• Estimated incidence of new TB cases (15-44 age group): 75%

• Estimated all TB deaths (annual): 107/100,000

• The HIV prevalence rate (2005): 23.2%

• HIV positive among TB : 64% (WHO 2007), 80% (NTP 2008)

• MDR-TB cases among all TB cases (2007): 105


Lesotho: LocationsLesotho: Locations

1 reference lab: QEII hospital

1 regional lab: Mafeteng government hospital


Before Renovation After renovation

Office of Microbiologist

Toilet

Microscopy, centrifuge, Incubator

Storage of chemicals,

stains & inspissator

Staining area

BSC

Refrigerator

Culture room

28thMay to 22ndJune

3m

MGIT 960, Fridge & Incubator

BSC

A/CBSC

Cntfg

3

5

2.5 m

2m

Neg. Air Pressure

Specimen receipt & Microscopy room

Sink

Sterilization room

Autoclave4

1

6

Sink

3.75m 3.25m

Culture room

7

Hand-wash

Toilet

InspiMedia room

BSC2

Entry

NTRL ifrastructure was established in 2 months

Central TB Laboratory ,QE II Hospital, MaseruCentral TB Laboratory ,QE II Hospital, Maseru


Facility Requirement* Central Lab, Maseru

Isolation of laboratory Yes Yes

Laboratory at the blind-end of building Desirable Yes

Room sealable for decontamination Yes Yes

Ventilation -inward airflow Yes Yes

-controlled ventilating system Yes Yes

-HEPA-filtered air exhaust Yes Yes

-Existing building @ at least 6 APH HEPA exhaust Yes Yes

-Monitors to check air pressure of containment room Yes Yes

Double-door entry Yes Yes

Airlock No No

Access through Anteroom Yes Yes

Anteroom with shower No No

Anteroom with hand-wash Desirable Yes

Effluent treatment Yes/No No

Autoclave -on site Yes Yes

-in laboratory room Desirable No

-double-ended Desirable No

Biological safety cabinets (BSC) class I or II, ducted outside Yes Yes, class II Type B

Personnel safety Monitoring Capacity Desirable Yes

NRL as per the WHO Bio-Safety normNRL as per the WHO Bio-Safety norm

* WHO requirements for liquid cultures, CDC & other agencies specifications for handling M. tb. culture


HEPA In-flow HEPA Exhaust

Negative air pressure facility & monitoringNegative air pressure facility & monitoring

Magnehelic gauge


Assigning the lab serial numberVerifying sputum

quality

ZN staining Microscopy

Laboratory activities in progressLaboratory activities in progress

Addition of mineral salt soln. Addition of Drugs

InspissationFilling & Labeling

Culture examination

Inoculation

Washing

Media section


Foundation for the Mol. Lab: July, 2008Foundation for the Mol. Lab: July, 2008

Start of molecular diagnosis: Sep. 2008Start of molecular diagnosis: Sep. 2008


Locations of the Lab facilitiesLocations of the Lab facilities

1 reference lab: QEII hospital

1 regional lab: Mafeteng government hospital


LERIBELeribeMmamohauButha buthiSebocheMokhotlong

MASERU*Maseru labScott’sSt. Joseph’sMakoanyaneBereaMaluti AdventistsSt.JamesParay

MAFETENGMohale’s HoekQuthingMachabengTebellongMafeteng

District Hospital Labs/Peripheral labs (MCs)-17

National Reference Lab (NRL)

Intermediate Reference Labs(Maseru*, Leribe & Mafeteng)

NRL to IRL

IRL to MCs

Smear Microscopy: EQA networkSmear Microscopy: EQA network


NTRL: Month wise sputum NTRL: Month wise sputum

smear & culture (2008)smear & culture (2008)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Ja

nu

ary

Fa

bru

ary

Ma

rch

Ap

ril

Ma

y

Ju

ne

Ju

ly

Au

gu

st

Se

pte

mb

er

Oc

tob

er

No

ve

mb

er

De

ce

mb

er

No

of

sp

ec

ime

n p

roc

es

se

d

0

10

20

30

40

50

60

70

80

90

100

Cu

ltu

re c

on

tam

ina

tio

n (

%)

Total culture processed ZN smear Culture contamination


Number of TB diagnostic tests performed (2009 to July 2010)

Number of EID HIV* diagnostic tests performed (Jan- July 2010)

Total tests Positive Placed on treatment722 137 35

NTRL: Integrated TB-HIV (EID) laboratoryNTRL: Integrated TB-HIV (EID) laboratory

*Only MDR-TB suspects request for DST; ** rapid DST for 'rif' and 'inh’- data includes QA/Training activities~ In addition: Solid culture and DST for 951 DRS samples and LED FM microscopy demonstration study in 2008-2009


MDR-TB LPA

EID for HIV by PCR

Molecular lab. in Maseru

Demonstration(Evidence)

WHO(Policy)

Implementation(Practice)

March 2007 LCApril 2008 LPA

June 2007 LCJune 2009 LPA

November 2007 LCNovember 2008 LPAApril 2009 EID for HIV by PCR

Partners• WHO• PIH• MOH (Lesotho)

Integrating HIV-TB diagnostics platformsIntegrating HIV-TB diagnostics platforms::


LESOTHOLESOTHO


Key Partners & SupportKey Partners & Support

FIND/GLI/GDF (UNITAID): HR: (In- country consultant; 2 Technicians), reagents for MGIT liquid culture, rapid speciation, Molecular Diagnosis (LPA with reagents), knowledge sharing and mentoring

PIH: Renovation of NTRL; Negative pressure facility; additional lab supplies; HR (3 technicians )

URC: HR (1 technician )

PEPFAR/CDC: Nation wide DRS

SNRL, Borstel : Support DRS

SNRL, MRC, Pretoria: EQA support for Smear, culture & Molecular Diagnosis

CDC, Atlanta: EID Training, EQA

BD: MGIT Instrument, HR support and reagents at the initial period

experience establishing tb laboratory capacity in lesotho dr vollepore find

Documents

board presentation

culture slide

government slide

maseru slide

tb laboratory capacity

mdrtb cases

months central tb laboratory

central lab