Strengthening National Lab. Network for diagnosis of TB and HIV: Challenges and solutions .

1. Strengthening National Lab. Network for diagnosis of TB and HIV: Challenges and solutions. Nicholas Wambua MD; MPH; DTCE. Technical Advisor -Tuberculosis CDC –Nairobi WHO/OGAC TB/HIV MEETING KIGALI

2. Presentation Outline • Overview of TB situation • TB laboratory services • Challenges in provision of TB lab services • Possible Solutions

5. HIV testing in TB sites • Decision on where HIV testing is done depends on: • TB caseload • available manpower • infrastructure • NLTP recommends: • TB Clinic • Next door room • Lab • VCT site • Testing by frontline TB clinicians / nurses/Lab Technicians • Targeting: • TB patient • Ultimately - TB suspect

6. Results of HIV testing: 2006 • Proportion tested = 60% • HIV prevalence = 52% • On CTX = 80% • On ARVs = 22%

7. Current Laboratory situation

8. Funding for TB laboratory services • MOH (NPHLS & NLTP): • Current partners: PEPFAR USAID GFATM MSF WHO/OGAC • Planned Partners: CIDA/KNCV (2007)

9. Challenges: Availability and accessibility • Inadequate No. of labs • Mal-distribution of laboratories • Inadequate space • Lack of interaction with private sector labs • Insufficient financial resources

10. Challenges: Human resources • Inadequate human resources at all levels • No career structures and opportunities • Motivation • training

11. Challenges: Quality Management Systems • Inadequate support supervision • Weak communication between NTP and Lab • Limited implementation of QA system • Poor maintenance of microscopes

12. Challenges: Weak Central Reference laboratory • Poor coordination (NLTP/NPHL/KEMRI) • Communication • Leadership • Funding • Physical infrastructure • Specimen logistics-transport and tracking • Difficulties in implementing EQA

13. Solutions: Availability and accessibility • Assess service coverage • Consider pop. distribution, transport, and TB prevalence • Involve private laboratory networks • Encourage use of national SOPs and training modules, supervision and EQA • Include funds for lab expansion in lab budgets

14. Solutions: Human Resources • Ensure sufficient staffing • Maximize use of existing HR • Provide career opportunities /progression • Improve salaries and work conditions • Training • Ensure current proficiency standards • Training on new techniques

15. Solutions: Quality Management Systems • Implement a well functioning QA system • Strengthen supervision and management at all levels • Develop a functional and sustainable maintenance system of microscopes

16. Solutions: Weak Central Reference laboratory • Regular meetings between NTP, CRL • Better planning with involvement of NTP • Include funds for lab expansion in lab budgets

17. Priorities for FY 08 Human Resources: • Staff training Infrastructure: • Renovations • Purchase of machines/equipment MDR TB • Specimen delivery, tracking and reporting systems • Culture and DST

18. Priorities for FY 08 Quality Management Systems • Coordination among partners and MOH • National EQA program • Support supervision • M&E

19. Thank you