Field and laboratory preparedness: challenges to rolling out new multidrug-resistant tuberculosis diagnostics

Griffin, AM; Caviedes, L; Gilman, R; Coronel, J; Delgado, F; Quispe, M; Moore, DA; (2009) Field and laboratory preparedness: challenges to rolling out new multidrug-resistant tuberculosis diagnostics. Revista panamericana de salud publica = Pan American journal of public health, 26 (2). pp. 120-7. ISSN 1020-4989 DOI:

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OBJECTIVES: In a pilot implementation project of the microscopic-observation drug-susceptibility methodology, we conducted a process evaluation to identify health system and logistic challenges that need to be addressed in order to harness the benefits of rolling out promising new diagnostic tools for multidrug-resistant tuberculosis (MDRTB). METHODS: Regional data relating to health system practices and performance related to the MDRTB diagnostic algorithm were collected at health center, local, and regional laboratories. RESULTS: Parallel implementation of a new test and an existing method creates demands on funds, personnel, sample transport, and information systems in addition to new test startup costs. Obviating the need for primary culture at intermediate laboratories through direct drug susceptibility testing (DST) at the regional reference laboratory significantly reduces delay. Field application of well-defined national guidelines for DST is patchy. If fidelity to national guidelines were perfect, DST requests would increase more than 50-fold, with important implications for laboratory capacity. CONCLUSIONS: Implementing a new MDRTB diagnostic presents challenges to the laboratory environment, the existing DST process, and the application of national guidelines in peripheral clinics. Assessing each element can maximize efficient use of a new tool. Specifically, strengthening systems for transferring samples to the laboratory and delivering results to the requesting clinic in addition to investing in personnel and laboratory resources are integral to harnessing the benefits of high-performance new diagnostic tests and can bring added value to other programs in the health care system.

Item Type: Article
Keywords: Laboratories/*organization & administration/statistics & numerical data, Microbial Sensitivity Tests, Tuberculosis, Multidrug-Resistant/*diagnosis/*microbiology, Laboratories, organization & administration, statistics & numerical data, Microbial Sensitivity Tests, Tuberculosis, Multidrug-Resistant, diagnosis, microbiology
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: TB Centre
PubMed ID: 19814891
Web of Science ID: 270683800004


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