Field and laboratory preparedness: challenges to rolling out new multidrug-resistant tuberculosis diagnostics Preparativos de campo y laboratorio: retos para la introducción de nuevos diagnósticos de la tuberculosis multirresistente

• Main Authors: Anne M. J. Griffin, Luz Caviedes, Robert Gilman, Jorge Coronel, Freddy Delgado, MaryLuz Quispe, avid A. J. Moore
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2009
• Subjects: Mycobacterium tuberculosis; tuberculosis resistente a múltiples medicamentos; implementación de plan de salud; técnicas de laboratorio clínico; Perú; tuberculosis; multidrug-resistant; health plan implementation; clinical laboratory techniques; Peru; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doaj.org/article/d66118c2007447bcbdfe32ad5a84ecc2

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. OBJETIVOS: En un proyecto piloto para la implementación de la metodología de observación microscópica para determinar la susceptibilidad a medicamentos se identificaron los retos logísticos y del sistema de salud que se deben atender para aprovechar los beneficios de nuevas y prometedoras herramientas diagnósticas para la ...