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