Strengthening TB Laboratory Capacity
Insufficient laboratory diagnostic capacity prevents an effective response to the challenges of TB-HIV co-infection, smear-negative TB and drug-resistant TB. Gap analyses have confirmed that such a response requires the urgent and massive scale-up of laboratory services, including related human resources. The lack of TB laboratory capacity constitutes a crisis, requiring a paradigm shift in providing laboratory policy guidance, quality assurance and knowledge-creation within national laboratory networks.
Laboratory capacity-building needs to reflect the scale-up plans for MDR-TB response and TB/HIV activities as well as take opportunities for cross-cutting collaboration between disease programmes (e.g. malaria, dengue, HIV and other emerging infectious diseases). New diagnostics, which are easy to operate, offer opportunities to decentralize the diagnosis of drug-resistant TB, to reduce the turn- around time of MDR-TB diagnostics from months to hours, to increase the sensitivity of TB diagnosis compared to conventional methods and to share equipment and human resources with other disease programmes. At the same time, it is critical that every identified TB patient has access to quality care and treatment through alignment with national TB strategic plans and MDR-TB scale-up plans.
Laboratory strengthening for TB control involves the following:
- A thorough analysis of the available national laboratory capacity in relation to plans to scale up the diagnosis of drug resistant and smear-negative TB. This analysis should be repeated periodically.
- Developingnational laboratory network plans (and diagnostic algorithms) that clearly describe roles and responsibilities of laboratories at all levels of the system to reach out to all, including smear-negative TB patients, children and MDR-TB patients, including external quality-control procedures and human resource development needs.
- Strengthening of Supranational Reference Laboratories to provide assistance to countries to train laboratory technicians, apply to donors such as the Global Fund, to select and procure appropriate equipment, to coordinate proficiency testing of national reference laboratories, and to apply sound biosafety measures.