Field and laboratory preparedness: challenges to rolling out new multidrug-resistant tuberculosis diagnostics

Griffin, Anne M.J.; Caviedes, Luz; Gilman, Robert H.; Coronel, Jorge; Delgado, Freddy; Quispe, Mary Luz; Moore, David

doi:10.1590/s1020-49892009000800004

Cited by 4 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of adherence by clinicians to re‐treatment protocols can have a devastating impact on the ability to identify MDR‐TB cases in the community. In one study from Peru, perfect adherence by clinical staff to national re‐treatment guidelines would have resulted in a 50‐fold increase in DST requests (Griffin et al. 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Clinical staff is generally not trained to set up accession and tracking systems in the same manner that laboratories are; many clinics have no record of which patient had a specimen collected or when the specimen was sent to the laboratory. Logistical dilemmas in the operational mechanism may result in up to 29% of confirmed MDR‐TB cases having ‘lost’ results (Griffin et al. 2009).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Increasing access to the MDR‐TB surveillance programme through a collaborative model in western Kenya*

Park

Magut

Gardner

et al. 2011

Tropical Med Int Health

View full text Add to dashboard Cite

ObjectiveKenya, like many resource-constrained countries, has a single mycobacterial laboratory, centrally located in Nairobi, with capacity for drug-susceptibility testing (DST) – the gold standard in diagnosing drug-resistant tuberculosis. We describe and evaluate a novel operational design that attempts to overcome diagnostic delivery barriers.MethodsReview of the public DST programme identified several barriers limiting access: lack of programme awareness amongst physicians, limited supplies, unreliable transport and no specimen tracking methods. Staff visited 19 clinic sites in western Kenya and trained healthcare providers in regard to the novel diagnostics model. Provincial laboratory registries were reviewed to assess utilization of DST services prior to and after programme modification.ResultsOnsite training consisted of the inclusion criteria for re-treatment patients – the high-priority group for DST. Additionally, infrastructural support established a stable supply chain. An existing transport system was adapted to deliver sputum specimens. Task shifting created an accession and tracking system of specimens. During the 24 months post-implementation, the number of re-treatment specimens from the catchment area increased from 9.1 to 23.5 specimens per month. In comparing annual data pre- and post-implementation, the proportion of re-treatment cases receiving DST increased from 24.7% (n = 403) to 32.5% (n = 574) (P < 0.001), and the number of multidrug-resistant (MDR) TB cases increased from 5 to 10 cases.ConclusionThe delivery model significantly increased the proportion of re-treatment cases receiving DST. Barriers to accessing the national MDR-TB surveillance programme can be overcome through an operational model based on pragmatic use of existing services from multiple partners.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increasing access to the MDR‐TB surveillance programme through a collaborative model in western Kenya*

Park

Magut

Gardner

et al. 2011

Tropical Med Int Health

View full text Add to dashboard Cite

show abstract

Alternative Methods of Diagnosing Drug Resistance—What Can They Do for Me?

Moore

Shah

2011

The Journal of Infectious Diseases

View full text Add to dashboard Cite

During the last decade considerable attention has been focussed upon the development of new technologies and methodologies for detection of drug resistance in Mycobacterium tuberculosis. There is a growing acknowledgement that the redundancy in testing a full panel of first-line drugs is an unaffordable indulgence; since only resistance at baseline to either (or both) of the two most potent agents, isoniazid (H) and rifampicin (R), would usually prompt therapeutic modification there is a shift towards initial RH (or R alone for selected genotypic technologies) drug susceptibility testing (DST) followed, if necessary by further extended first and second line agent (currently phenotypic) DST. Most of the new drug susceptibility tests endorsed by the World Health Organization since 2007 deliver rapid RH (or R alone for selected genotypic technologies) DST. Targeting of patient groups with risk factors for drug resistance increases the proportion of tests that identify drug resistance, but in many settings at least as many patients with drug resistant disease will have no identifiable risk factors--equity of care demands that universal RH DST at baseline should be the goal. We review the bewildering array of choices facing TB program directors and attempt to provide objective information to help in deciding what tools may be best suited to different environments.

show abstract

Strategies to Enhance Diagnostic Capabilities for the New Drug-Resistant Tuberculosis (DR-TB) Drugs

Saktiawati,

Vasiliu,

Saluzzo

et al. 2024

Pathogens

View full text Add to dashboard Cite

The global burden of drug-resistant tuberculosis (DR-TB) continues to challenge healthcare systems worldwide. There is a critical need to tackle DR-TB by enhancing diagnostics and drug susceptibility testing (DST) capabilities, particularly for emerging DR-TB drugs. This endeavor is crucial to optimize the efficacy of new therapeutic regimens and prevent the resistance and overuse of these invaluable weapons. Despite this urgency, there remains a lack of comprehensive review of public health measures aimed at improving the diagnostics and DST capabilities. In this review, we outline strategies to enhance the capabilities, especially tailored to address the challenges posed by resistance to new DR-TB drugs. We discuss the current landscape of DR-TB drugs, existing diagnostic and susceptibility testing methods, and notable gaps and challenges in these methods and explore strategies for ensuring fair access to DST while narrowing these disparities. The strategies include public health interventions aimed at strengthening laboratory infrastructure, workforce training, and quality assurance programs, technology transfer initiatives, involving drug developers in the DST development, establishing national or regional referral hubs, fostering collaboration and resources pooling with other infection control efforts, extending testing access in underserved areas through public–private partnerships, advocating for lowering costs or loans at low interest, remote technical support, and implementing mandatory molecular surveillance monitoring. This review underscores the urgent need to enhance DST capacities for new DR-TB drugs and identifies opportunities for innovation and improvement. Assessing the extent of the global health impact of these measures is crucial to ensure their effectiveness in combating DR-TB.

show abstract

Field and laboratory preparedness: challenges to rolling out new multidrug-resistant tuberculosis diagnostics

Cited by 4 publications

References 7 publications

Increasing access to the MDR‐TB surveillance programme through a collaborative model in western Kenya*

Increasing access to the MDR‐TB surveillance programme through a collaborative model in western Kenya*

Alternative Methods of Diagnosing Drug Resistance—What Can They Do for Me?

Strategies to Enhance Diagnostic Capabilities for the New Drug-Resistant Tuberculosis (DR-TB) Drugs

Contact Info

Product

Resources

About