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Experience establishing TB Laboratory capacity in Lesotho

Experience establishing TB Laboratory capacity in Lesotho. Dr Vollepore FIND. FIND Approach. Based on Product needs Local needs and capacity Appropriate level of healthcare system Collaborative with partners International partners

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Experience establishing TB Laboratory capacity in Lesotho

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  1. Experience establishing TB Laboratory capacity in Lesotho Dr Vollepore FIND

  2. FIND 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)

  3. Lesotho: 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

  4. Lesotho: Locations • 1 reference lab: QEII hospital • 1 regional lab: Mafeteng government hospital

  5. 3.25m 3.75m Cntfg BSC Staining area Neg. Air Pressure Storage of chemicals, stains & inspissator MGIT 960, Fridge & Incubator BSC 2.5 m 3 3m 6 BSC Culture room A/C Culture room 4 Autoclave Microscopy, centrifuge, Incubator Media room Inspi Sterilization room 2m Refrigerator 5 2 BSC Sink Sink Toilet Toilet Office of Microbiologist 7 Specimen receipt & Microscopy room 1 Hand-wash Entry Central TB Laboratory ,QE II Hospital, Maseru 28thMay to 22ndJune After renovation Before Renovation NTRL ifrastructure was established in 2 months

  6. NRL as per the WHO Bio-Safety norm * WHO requirements for liquid cultures, CDC & other agencies specifications for handling M. tb. culture

  7. Magnehelic gauge Negative air pressure facility & monitoring HEPA In-flow HEPA Exhaust

  8. Laboratory activities in progress Media section Inoculation Verifying sputum quality Assigning the lab serial number Addition of mineral salt soln. Addition of Drugs Inspissation Culture examination Washing Filling & Labeling ZN staining Microscopy

  9. Foundation for the Mol. Lab: July, 2008 Start of molecular diagnosis: Sep. 2008

  10. Locations of the Lab facilities • 1 reference lab: QEII hospital • 1 regional lab: Mafeteng government hospital

  11. District Hospital Labs/ Peripheral labs (MCs)-17 LERIBE Leribe Mmamohau Buthabuthi Seboche Mokhotlong MASERU* Maseru lab Scott’s St. Joseph’s Makoanyane Berea Maluti Adventists St.James Paray MAFETENG Mohale’sHoek Quthing Machabeng Tebellong Mafeteng Smear Microscopy: EQA network National Reference Lab (NRL) NRL to IRL Intermediate Reference Labs (Maseru*, Leribe & Mafeteng) IRL to MCs

  12. NTRL: Month wise sputum smear & culture (2008)

  13. NTRL: Integrated TB-HIV (EID) laboratory Number of TB diagnostic tests performed (2009 to July 2010) Number of EID HIV* diagnostic tests performed (Jan- July 2010) *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

  14. Integrating HIV-TB diagnostics platforms: EID for HIV by PCR MDR-TB LPA Molecular lab. in Maseru WHO (Policy) Implementation (Practice) Demonstration (Evidence) March 2007 LC April 2008 LPA June 2007 LC June 2009 LPA November 2007 LC November 2008 LPA April 2009 EID for HIV by PCR • Partners • WHO • PIH • MOH (Lesotho)

  15. LESOTHO

  16. Key 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

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