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Laboratory and Diagnosis

Laboratory and Diagnosis. Dr R Ramachandran 5 th Joint International Monitoring Mission to Review NTP Thailand. Situation. Functional quality assured nationwide smear microscopy network (1081)

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Laboratory and Diagnosis

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  1. Laboratory and Diagnosis Dr R Ramachandran 5th Joint International Monitoring Mission to Review NTP Thailand 5th JMM Thailand

  2. Situation • Functional quality assured nationwide smear microscopy network (1081) • Current 5 year plan for network of 66 culture labs, 32 FLDST labs is under progress, to be completed 2015 • Second Line DST available (MGIT) at NTRL Bangkok (SRL) and Siriraj/Ramathibodi University Hospital (will need to be proficiency tested by NTRL /SRL • Molecular diagnostics LPA (Hain– 12) (YD - 4) RT PCR (GeneXpert -14) (Seegene- 8) 5th JMM Thailand

  3. Issues • National policy for sputum collection for diagnosis and follow-up during treatment not uniformly followed • Quality of sputum, staining variable (volume, salivary specimen) • Low smear positivity rate (use of kinyoun cold staining, low sensitivity of conventional light microscopy) • Culture and DST facilities and molecular tools under-used for diagnosis and follow up of TB and DR TB • Laboratory information systems not synchronized with clinical information systems • Many laboratories outside DDC system perform TB diagnostics; not monitored or effectively included in policy dissemination • Laboratories not accredited for TB diagnostic services (culture & DST) 5th JMM Thailand

  4. Recommendations (1) • Address sputum specimen quality, safety • Strictly implement sputum collection policy (especially the 2nd early morning specimen) • Improve sputum quality by training and education of HCW and patients • To improve smear microscopy sensitivity • Replace Kinyoun cold staining with Ziehl-Neelsenstaining • Replace conventional microscopy with LED FM in appropriate settings • Expand access and rational use of newer more sensitive molecular tools to improve case detection of all forms of TB including DR TB • Optimally utilize the culture and DST facilities for management of TB and DR TB 5th JMM Thailand

  5. Recommendations (2) • Link the LMIS to electronic case record system and build capacity for analysis of laboratory indicators to improve performance and throughput • Develop strategies to engage all laboratories with policy and quality standards, beyond DDC network • Enhance quality supervision for EQA (smear) through NTRL/RRL • Ensure that all laboratories providing TB diagnostic services are accredited 5th JMM Thailand

  6. Thank You 5th JMM Thailand

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