Foundation for Innovative New Diagnostics, Geneva CH-1216, Switzerland. cn.paramasivan@fi nddiagnostics.org
Int J Tuberc Lung Dis. 2010 Jan;14(1):59-64.
To describe the experience of strengthening laboratory diagnosis of tuberculosis (TB) in a resource-limited country with high TB-HIV (human immunodeficiency virus) and multidrug-resistant TB (MDR-TB) prevalence.
In the Kingdom of Lesotho, which is confronted with high levels of TB, MDR-TB and HIV prevalence, between 2006 and 2008 a coalition of the Foundation for Innovative New Diagnostics, Partners In Health and the World Health Organization renovated the National TB Reference Laboratory and reinforced microscopy services, streamlined conventional culture and drug susceptibility testing (DST) and introduced modern TB diagnostic methods.
It was feasible to establish a biosafety level three facility for solid culture and DST and an external quality assessment programme for smear microscopy within 4 months, all in 2007. Liquid culture and DST were introduced a month later. Preliminary results were comparable to those found in laboratories in industrialised countries. A year later, line-probe assay for the rapid detection of MDR-TB was introduced.
Through strong political commitment and collaboration, it is possible to rapidly establish quality assured TB diagnostic capacity, including current methods, in a resource-limited setting. Case detection and management for TB and MDR-TB have been greatly enhanced. From a low baseline, TB culture throughput in the laboratory increased ten-fold and has been sustained. This experience has served as a catalyst to translate policy into practice with new diagnostic technologies. It supports global policy setting to enhance and modernise laboratory work in developing countries.
描述在一个资源有限、结核病（TB）-人类免疫缺陷病毒（HIV）和耐多药结核病（MDR-TB）流行率高的国家加强结核病实验室诊断的经验。
在莱索托王国，面临着结核病、MDR-TB 和 HIV 高流行率的挑战，2006 年至 2008 年期间，创新诊断基金会、健康伙伴关系和世界卫生组织联盟对国家结核病参考实验室进行了翻新，并加强了显微镜服务，简化了常规培养和药物敏感性测试（DST），并引入了现代结核病诊断方法。
在 2007 年的 4 个月内，成功建立了一个用于固体培养和 DST 的三级生物安全设施以及一个用于涂片显微镜检查的外部质量评估计划。一个月后引入了液体培养和 DST。初步结果与工业化国家实验室的结果相当。一年后，引入了用于快速检测 MDR-TB 的线探针分析。
通过强有力的政治承诺和合作，有可能在资源有限的环境中快速建立质量保证的结核病诊断能力，包括当前的方法。结核病和 MDR-TB 的病例发现和管理得到了极大的加强。从一个低的基线开始，实验室的结核病培养量增加了十倍，并得以持续。这一经验成为了将政策转化为实践的催化剂，采用了新的诊断技术。它支持全球政策制定，以加强和现代化发展中国家的实验室工作。
