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Scale-up of multidrug-resistant tuberculosis laboratory services, Peru.

Shin SS, Yagui M, Ascencios L, Yale G, Suarez C, Quispe N, Bonilla C, Blaya J, Taylor A, Contreras C, Cegielski P - Emerging Infect. Dis. (2008)

Bottom Line: Implementation involved training providers on DST indications, validating conventional and rapid first-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting.Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation.Operational research guided laboratory scale-up and identified barriers to effective capacity building.

View Article: PubMed Central - PubMed

Affiliation: Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA. sshin@partners.org

ABSTRACT
Over the past 10 years, the Peruvian National Tuberculosis (TB) Program, the National Reference Laboratory (NRL), Socios en Salud, and US partners have worked to strengthen the national TB laboratory network to support treatment of multidrug-resistant TB. We review key lessons of this experience. The preparation phase involved establishing criteria for drug susceptibility testing (DST), selecting appropriate DST methods, projecting the quantity of DST and culture to ensure adequate supplies, creating biosafe laboratory facilities for DST, training laboratory personnel on methods, and validating DST methods at the NRL. Implementation involved training providers on DST indications, validating conventional and rapid first-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting. Monitoring included ongoing quality control and quality assurance procedures. Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation. Operational research guided laboratory scale-up and identified barriers to effective capacity building.

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Drug susceptibility testing (DST) performed in Peru, by method and year.
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Figure 2: Drug susceptibility testing (DST) performed in Peru, by method and year.

Mentions: As the MDR TB treatment program expanded in absolute numbers and geographic coverage, so too did demand for laboratory services. From 1996 through 2000, the number of mycobacterial cultures and DSTs performed yearly more than doubled (Figures 1, 2). The process of program scale-up posed additional challenges in patient management, information systems, drug procurement, and regional implementation. Responding to these needs, the Bill & Melinda Gates Foundation awarded a grant for $45 million in 2000 to establish a consortium called PARTNERS, whose principal task was to achieve national coverage of MDR TB treatment in Peru and replicate this project elsewhere. Several key institutions were added to the initial group of collaborators: WHO, the Centers for Diseases Control and Prevention (CDC), and the Task Force for Child Survival and Development. Within the PARTNERS consortium, the Laboratory Improvement Project was established with specialists from MSLI, CDC, Harvard University, PIH, and INS.


Scale-up of multidrug-resistant tuberculosis laboratory services, Peru.

Shin SS, Yagui M, Ascencios L, Yale G, Suarez C, Quispe N, Bonilla C, Blaya J, Taylor A, Contreras C, Cegielski P - Emerging Infect. Dis. (2008)

Drug susceptibility testing (DST) performed in Peru, by method and year.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2600242&req=5

Figure 2: Drug susceptibility testing (DST) performed in Peru, by method and year.
Mentions: As the MDR TB treatment program expanded in absolute numbers and geographic coverage, so too did demand for laboratory services. From 1996 through 2000, the number of mycobacterial cultures and DSTs performed yearly more than doubled (Figures 1, 2). The process of program scale-up posed additional challenges in patient management, information systems, drug procurement, and regional implementation. Responding to these needs, the Bill & Melinda Gates Foundation awarded a grant for $45 million in 2000 to establish a consortium called PARTNERS, whose principal task was to achieve national coverage of MDR TB treatment in Peru and replicate this project elsewhere. Several key institutions were added to the initial group of collaborators: WHO, the Centers for Diseases Control and Prevention (CDC), and the Task Force for Child Survival and Development. Within the PARTNERS consortium, the Laboratory Improvement Project was established with specialists from MSLI, CDC, Harvard University, PIH, and INS.

Bottom Line: Implementation involved training providers on DST indications, validating conventional and rapid first-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting.Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation.Operational research guided laboratory scale-up and identified barriers to effective capacity building.

View Article: PubMed Central - PubMed

Affiliation: Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA. sshin@partners.org

ABSTRACT
Over the past 10 years, the Peruvian National Tuberculosis (TB) Program, the National Reference Laboratory (NRL), Socios en Salud, and US partners have worked to strengthen the national TB laboratory network to support treatment of multidrug-resistant TB. We review key lessons of this experience. The preparation phase involved establishing criteria for drug susceptibility testing (DST), selecting appropriate DST methods, projecting the quantity of DST and culture to ensure adequate supplies, creating biosafe laboratory facilities for DST, training laboratory personnel on methods, and validating DST methods at the NRL. Implementation involved training providers on DST indications, validating conventional and rapid first-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting. Monitoring included ongoing quality control and quality assurance procedures. Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation. Operational research guided laboratory scale-up and identified barriers to effective capacity building.

Show MeSH
Related in: MedlinePlus