Lab Matters Spring 2019 - Page 22

GLOBAL HEALTH Building TB Testing Capacity in Sierra Leone By Shirematee Baboolal, PhD, consultant In Sierra Leone, tuberculosis exacts a heavy burden. In 2018 alone, there were more than 17,000 notified cases of the disease in a country with a population of less than 8 million. Since 2016, APHL has engaged with the country’s Ministry of Health and Sanitation to provide technical assistance to the National TB Reference Laboratory (NTRL) to build its TB testing capacity for culture and drug sensitivity testing (DST). Initially this capacity was limited. In 2016 the NTRL was still a new entity with uncompleted facilities. Formed in 2014 under the country’s National Tuberculosis Program, it performed only acid fast bacilli smear microscopy using the Ziehl-Neelson stain and GeneXpert MTB/RIF. There was no facility available for TB culture. APHL began by modifying several small rooms in the NTRL facility to perform concentration of samples, solid culture and line probe assay (LPA) (first line). It leverage equipment available for LPA and borrowed other equipment from the Central Public Reference Laboratory to train staff in molecular LPA. AFRO SLIPTA checklist. At baseline, the NTRL scored 57/275 points, which was equivalent to zero stars under the rating system. APHL trained NTRL staff to build and sustain QMS in a step-wise manner focusing on documentation, practice and competency building. Though several key areas remain to be addressed, a SLIPTA audit in March 2019 showed significant improvement with a score of 214/275, equivalent to a three star rating. With support from The Global Fund, a modular laboratory was purchased with all equipment and supplies for conducting solid and liquid culture as well as DST for first- and second-line drugs. This facility was installed and commissioned in February 2019. Training was conducted on liquid culture and DST utilizing the BD MGIT ™ TB System. The laboratory can now conduct both phenotypic culture and DST for several drugs, including Streptomycin, Isoniazid (0.1µg and 0.4µg), Rifampicin, Ethambutol and Pyrazinamide, as well as LPA for first and second line drugs. Second line drugs for phenotypic testing will be added to the test algorithm soon. n Dr. Baboolal training staff in the new laboratory at NTRL The following year, APHL introduced quality management systems (QMS) with a baseline assessment using the WHO/ APHL Publishes Guide to Lab Facility Construction, Renovation By Palmira Mangae, specialist, Global Health As part of its commitment to continuously improve the public health laboratory system, APHL has published new Laboratory Facility Construction and Major Renovations Guidelines. Developed in collaboration with HDR, Global Health Committee members and consultants, this multifaceted resource will help public health laboratory leaders and stakeholders think comprehensively about their facility’s needs, functions and sustainability. Laboratory Facility Construction and Major Renovations Guidelines The guide provides an overview of core activities in the laboratory design process based on lessons learned and best practices in laboratory development and renovation. The information helps laboratory teams walk through the design process so that their construction project is a success—not only in design, but operationally. MAY 2019 For more information, please contact Palmira For more information, please contact Mangae Palmira Mangae ® 20 LAB MATTERS Spring 2019 PublicHealthLabs @APHL APHL.org