TB/HIV Community Activism - Building Community Support for TB-HIV Research
Strengthening National Lab. Network for diagnosis of TB and HIV: Challenges and solutions .
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Transcript of Strengthening National Lab. Network for diagnosis of TB and HIV: Challenges and solutions .
Strengthening National Lab. Network for diagnosis of TB
and HIV: Challenges and solutions.
Nicholas Wambua MD; MPH; DTCE.Technical Advisor -Tuberculosis
CDC –Nairobi
WHO/OGAC TB/HIV MEETINGKIGALI
Presentation Outline
• Overview of TB situation
• TB laboratory services
• Challenges in provision of TB lab services
• Possible Solutions
NLTP Kenya - TB Case Finding: 1987 - 2006
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
'87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06
Year
Nu
mb
ers
of
rep
ort
ed c
ases
Smear Positive Pulmonary TB
Smear Negative Pulmonary TB
Extra Pulmonary TB
Retreatment Cases
All TB
Trend of HIV testing in TB patients: Kenya
0
10
20
30
40
50
60
70
80
90
Q3/05 Q4/05 Q1/06 Q2/06 Q3/06 Q4/06 Target
Time (quarter/Year)
Perc
ent t
este
d
HIV testing in TB sites
• Decision on where HIV testing is done depends on:– TB caseload – available manpower – infrastructure
• NLTP recommends:• TB Clinic• Next door room• Lab• VCT site
• Testing by frontline TB clinicians / nurses/Lab Technicians
• Targeting:TB patientUltimately - TB suspect
Results of HIV testing: 2006
• Proportion tested = 60%
• HIV prevalence = 52%
• On CTX = 80%
• On ARVs = 22%
Current Laboratory situation
Funding for TB laboratory services
• MOH (NPHLS & NLTP):
• Current partners:PEPFAR
USAID
GFATM
MSF
WHO/OGAC
• Planned Partners:CIDA/KNCV (2007)
Challenges: Availability and accessibility
• Inadequate No. of labs
• Mal-distribution of laboratories
• Inadequate space• Lack of interaction
with private sector labs
• Insufficient financial resources
Challenges: Human resources
• Inadequate human resources at all levels
• No career structures and opportunities
• Motivation• training
Challenges: Quality Management Systems
• Inadequate support supervision
• Weak communication between NTP and Lab
• Limited implementation of QA system
• Poor maintenance of microscopes
Challenges: Weak Central Reference laboratory
• Poor coordination (NLTP/NPHL/KEMRI)– Communication– Leadership– Funding
• Physical infrastructure• Specimen logistics-transport and
tracking• Difficulties in implementing EQA
Solutions: Availability and accessibility
• Assess service coverage– Consider pop. distribution, transport, and
TB prevalence
• Involve private laboratory networks– Encourage use of national SOPs and
training modules, supervision and EQA
• Include funds for lab expansion in lab budgets
Solutions: Human Resources
• Ensure sufficient staffing • Maximize use of existing HR• Provide career opportunities
/progression• Improve salaries and work conditions• Training
– Ensure current proficiency standards– Training on new techniques
Solutions: Quality Management Systems
• Implement a well functioning QA system
• Strengthen supervision and management at all levels
• Develop a functional and sustainable maintenance system of microscopes
Solutions: Weak Central Reference laboratory
• Regular meetings between NTP, CRL• Better planning with involvement of NTP• Include funds for lab expansion in lab
budgets
Priorities for FY 08
Human Resources:• Staff trainingInfrastructure:• Renovations• Purchase of machines/equipment MDR TB• Specimen delivery, tracking and reporting
systems• Culture and DST
Priorities for FY 08
Quality Management Systems
• Coordination among partners and MOH
• National EQA program
• Support supervision
• M&E
Thank you