World Bank Grant for Strengthening of TB Laboratories

1. World Bank GrantforStrengthening of TB Laboratories Shirematee Baboolal Technical Coordinator, Microbiology/Medical Entomology 1

2. Introduction • This project is part of a World Bank grant to CARICOM to support the Pan Caribbean partnership against HIV/AIDS

3. This grant will provide the following to CAREC and CMCs • Strengthening the HIV/AIDS laboratory infrastructure at CAREC • Strengthening of related laboratory information systems and connectivity between CAREC and CMCs • Strengthening the laboratory infrastructure for TB reference work at CAREC

4. Strengthening the HIV/AIDS laboratory infrastructure at CAREC • Service provision to CMCs to support HIV/AIDS care and treatment programmes • Service provision to CMCs to support prevention of mother to child transmission of HIV • Equipping a new molecular biology laboratory at CAREC

5. Strengthening the HIV/AIDS laboratory infrastructure at CAREC • Training of laboratory professionals for diagnosis and use of new techniques • Strengthening of quality assurance and control mechanisms • Introduction of new techniques to monitor HIV subtypes and resistance patterns in the region

6. Strengthening of related laboratory information systems • Development of clinical data management systems • Development of interface with existing clinical management systems and LABIS • Implementation of these systems at 5 sites

7. Strengthening the TB laboratory • Renovation and expansion of the TB laboratory at CAREC • Purchase of equipment • Continue reference testing • Conduct surveys of drug resistance • Proficiency testing

8. Strengthening the TB laboratory • Quality assurance • In country assessment and training in laboratory methods • Regional training workshop on critical aspect of TB control

9. Renovation and expansion of the TB laboratory at CAREC • Presently the TB laboratory is very small and consists of one room for testing only • Can only permit handling of a limited number of specimens • Construct two larger rooms – one to be used for testing, the other for microscopy and paper work

10. Purchase of equipment • Presently we use the BACTEC 460 for isolation, identification and susceptibility testing • This machine is now obsolete and parts are no longer available • Purchase a BACTEC 960 – this can accommodate more specimens – isolation • Continue to use the 460 for susceptibility testing.

11. Purchase of equipment • Larger biological safety cabinet • -70 freezer • Computer • Water bath etc.

12. Continue reference testing • Continue isolation and identification from CMCs unable to do this • Perform identification of isolates using Gen probe – M.tuberculosis complex,M. avium complexand M. kansasii • Continue susceptibility testing against 5 first line drugs (S.I.R.E, PZA)

13. Quality assurance • Presently only one laboratory is involved in the smear validation programme • Set up programme to strengthen smear validation in each laboratory • Procedure will be discussed in the laboratory break out session tomorrow

14. Proficiency testing • Presently AFB smears are sent to 22 laboratories in CMCs • Expand this to all laboratories performing AFB staining and microscopy • Evaluate results and make necessary interventions

15. In country assessment and training in laboratory methods • Data has been collected re TB capacity in each country – EU • May need to do country visits • Training in AFB methods – ZN and FA stains • Training in culture methods – LJ, BACTEC • Training in identification methods – BACTEC, DNA probe • Training in susceptibility testing - BACTEC

16. Survey of drug resistance • To include 5 priority countries (to be decided here) • Proposal to be written with the participating countries • Depending on laboratory capacity, testing will be done in-country and at CAREC

17. 3-year workplan • See handout

18. Please think about how this grant can assist in building/strengthening laboratory capacity in your country 18

19. Bring back suggestions to discussion tomorrow 19

20. Thank You 20