TY - JOUR
T1 - Field and laboratory preparedness
T2 - Challenges to rolling out new multidrugresistant tuberculosis diagnostics
AU - Griffin, Anne M.J.
AU - Caviedes, Luz
AU - Gilman, Robert
AU - Coronel, Jorge
AU - Delgado, Freddy
AU - Quispe, Mary Luz
AU - Moore, David A.J.
PY - 2009/8
Y1 - 2009/8
N2 - Objectives. In a pilot implementation project of the microscopic- observation drugsusceptibility 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.
AB - Objectives. In a pilot implementation project of the microscopic- observation drugsusceptibility 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.
KW - Clinical laboratory techniques
KW - Health plan implementation
KW - Mycobacterium tuberculosis
KW - Peru
KW - Tuberculosis, multidrug-resistant
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U2 - 10.1590/S1020-49892009000800004
DO - 10.1590/S1020-49892009000800004
M3 - Article
C2 - 19814891
AN - SCOPUS:70350314976
SN - 1020-4989
VL - 26
SP - 120
EP - 127
JO - Revista Panamericana de Salud Publica/Pan American Journal of Public Health
JF - Revista Panamericana de Salud Publica/Pan American Journal of Public Health
IS - 2
ER -