1 / 20

Building Laboratory Capacity

Building Laboratory Capacity. Egypt. Egypt has more than 70 million population in 27 governorates. Annual TB incidence of new positive cases is 12/100,000, with 5,000 new positive TB cases and 12,000 TB cases all types notified to the NTP each year. Introduction.

skah
Download Presentation

Building Laboratory Capacity

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Building Laboratory Capacity

  2. Egypt Egypt has more than 70 million population in 27 governorates. Annual TB incidence of new positive cases is 12/100,000, with 5,000 new positive TB cases and 12,000 TB cases all types notified to the NTP each year.

  3. Introduction • The first priority of NTP is case detection and cure by reliable diagnosis & effective treatment. • Since case finding relies heavily on laboratory diagnosis, so it is important to provide TB smear microscopy services that are accessible to the entire population, yet maintain an acceptable level of technical proficiency. • To accomplish this objective a network of laboratories with competency in acid fast sputum smear microscopy, supported by larger regional laboratories and over seen by a National Tuberculosis Reference Laboratory is required.

  4. Essential elements to build & maintain a Successful laboratory System (1) Updating Human Resources : • Training. • Attending conferences. • International Training. (2) Quality Assurance : • Internal Quality Control. • External Quality Assessment. • Quality Improvement.

  5. Essential elements to build & maintain a Successful laboratory System (Cont.) (3) Supervision System ( Central , Peripheral) . (4) Collaboration & Coordinate between NTP , NRL & Laboratory Coordinators in the governorates. (5) Allocation of separate budget for raising lab. capacity. (6) Increase culture capacity of laboratories.

  6. Organization of Laboratory Network in Egypt The centers are organized according to 3 levels of general health service : • Peripheral Laboratories: • Located at primary health centers or district hospital or TB dispensary . • Capable of doing DSM of sputum using ZN staining . • In Egypt it is 157 Peripheral Laboratories . • 52 lab. belonging to health insurance organization forDSM • 60-80 New diagnostic centers will be included out of which we have chosen 59 centers according to certain criteria.

  7. Organization of Laboratory Network in Egypt ( cont.) • IntermediateLaboratories: • Regional or provincial located in large hospitals or cities . • Staff have the technical proficiency to make DSM by ZN & capable of doing cultures. • In Egypt it is 18 Intermediate Laboratories .

  8. Organization of Laboratory Network in Egypt ( cont.) • National Tuberculosis Reference Laboratory : • It is part of Central Health Laboratories. • It was denoted by WHO as a Supranational lab. for EMRO region depending on the results of proficiency testing of DST last two years.

  9. Main Duties of Peripheral Laboratories • Direct smear microscopy for detecting infectious cases and monitor patient under treatment. • Participating in the quality • assurance program of direct • smear microscopy.

  10. Main Duties of Intermediate Laboratories for TB • To serve as a reference laboratory for TB for the governorate (direct microscopy & cultures ). • NB Culture is done only for suspects with 3 – ve smears • To supervise laboratory activities of all TB laboratories in the governorate. • Quality control on direct – smear microscopy • To train laboratory staff . • To participate in the surveillance of the TB drug resistance .

  11. Main Duties of National Reference Laboratories for TB • To maintain the highest technical quality. • Capable of doing DSM, Culture & identification and susceptibility testing. • Strengthen quality assurance program. • Supervising laboratory activities of all TB laboratories in the country • Training & supervise training of laboratory staff by the intermediate TB laboratories. • Monitoring the effectiveness of the NTP by constant surveillance of the TB drug resistance in the country. • Establish maintenance system for laboratory equipment .

  12. Activities done to Increase Capacity Laboratory Network in Egypt • Separate budget for laboratory network was allocated for equipment supply, training courses & supervision . • Coordination & collaboration between the NTP and NRL. • Attendance of regular quarterly meeting with NTP , GCT’s , NRL & lab. Coordinator to discuss achievement and constrains then try to put solution for improvement. • Introduction of Laboratory register in nominal electronic registration( Surveillance System).

  13. Activities done to Increase Capacity Laboratory Network in Egypt ( Cont.) • Updating National Laboratory Guideline to include all standardized procedures , QC measures , Lab registers, forms, Supervision Checklist. • 59 New diagnostic centers are chosen according to certain criteria so that the catchments area for one lab. is 250.000. These center are renovated , equipped and technicians trained. • Increase capability of culture laboratories. • No. of culture laboratories are increased from 12 in 2001 To 18 lab. 2005. • These laboratories are renovated , equipped and laboratory workers are trained .

  14. Training • Year 2005 • (10) courses for DSM : 110 Technicians • (3) Training courses for Culture : 27 Technicians. • (1) Training course for Yemen : 6 Technicians. • (1) Training course for Iraq : 3 Technicians. • Year 2006 • (1) Course for Iraq : 5 ( 1 Doctor , 2 Chemist , 2 Technicians) • (2) courses for DSM : 15 Technicians • (7) courses for New Diagnostic Lab. : 70 Technicians • (2) Courses for Doctors on QC : 16 Doctors • (2) Course for Culture : 17 Technicians

  15. Quality Control • We apply a system for Internal Quality Control of Direct Smear Microscopy and culture , forms are printed and distributed to lab. coordinator and lab. technicians in Peripheral lab. • External Quality assessment for direct smear microscopy for DSM started this year 2006. • A plan was put for EQA that based on WHO guidelines.

  16. Supervision of Intermediate Lab. • Modification of Supervision check list according to country needs. • A plan for supervisory visits has been organized in collaboration with the NTP. • Supervision of Peripheral Lab. by lab coordinator started from 1st quarter 2005 . Feed back are sent to Peripheral Lab. & NRL. • Reports include : Situational analysis . • Data base for the human resources equipment needed , slide positivity rate to decide the lot quality assurance sampling , reagents, forms….etc.

  17. Human Resources • Management course for lab. directors of NRL in EMRO region in Cairo , September 2005 funded by WHO. • Attendance of the Annual European Society of Mycobacteriology conference 2004, 2005 funded by TEBCTA , 2 participant from NRL. • Global Consultancy Training Workshop for NRL of TB Control by WHO for choosing lab. experts 2006. • Attending Subgroup of Laboratory Capacity strengthen (SLCS) and Supranational Meeting in 2002 , 2004 , 2005. • Attending Training Course in Belgium on 2nd Line Drug Susceptibility Testing 2005. 2 participant from NRL

  18. Challenges to providing mycobacterial culture capacity for all TB suspect (1) Need laboratory with special organization at least 3 rooms ( clean area for preparation of media , dirty area for decontamination & sterilization and culture room. (2) High cost of equipment needed for culture lab. (3) Media containing eggs like L.J are costly due to avian flu (4) Culture on solid media takes time from 3 – 8 weeks and rapid diagnostic methods are costly.

  19. Recommendation Establish culture lab in each governorates or province for the following cases : • Suspect with 3 – ve smears • Relapse , failure. • Confirmation of cure. • Extra-pulmonary samples. • For HIV +ve due to low bacillary load in sputum. • For children.

  20. Thank You

More Related