Centers for Disease Control and Prevention, Global AIDS Program, International Laboratory Branch, Atlanta, GA 30329, USA.
Clin Microbiol Rev. 2011 Apr;24(2):314-50. doi: 10.1128/CMR.00059-10.
With an estimated 9.4 million new cases globally, tuberculosis (TB) continues to be a major public health concern. Eighty percent of all cases worldwide occur in 22 high-burden, mainly resource-poor settings. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with HIV. Therefore, building capacity and enhancing universal access to rapid and accurate laboratory diagnostics are necessary to control TB and HIV-TB coinfections in resource-limited countries. The present review describes several new and established methods as well as the issues and challenges associated with implementing quality tuberculosis laboratory services in such countries. Recently, the WHO has endorsed some of these novel methods, and they have been made available at discounted prices for procurement by the public health sector of high-burden countries. In addition, international and national laboratory partners and donors are currently evaluating other new diagnostics that will allow further and more rapid testing in point-of-care settings. While some techniques are simple, others have complex requirements, and therefore, it is important to carefully determine how to link these new tests and incorporate them within a country's national diagnostic algorithm. Finally, the successful implementation of these methods is dependent on key partnerships in the international laboratory community and ensuring that adequate quality assurance programs are inherent in each country's laboratory network.
全球估计有 940 万例新发病例，结核病（TB）仍然是一个主要的公共卫生关注点。全世界所有病例中有 80%发生在 22 个高负担、主要是资源匮乏的国家。结核病对弱势群体造成的这种破坏性影响，也因其与艾滋病毒的致命协同作用而加剧。因此，在资源有限的国家，必须建立能力并加强普及快速和准确的实验室诊断，以控制结核病和结核-艾滋病毒双重感染。本综述描述了一些新的和已建立的方法，以及在这些国家实施质量结核病实验室服务所涉及的问题和挑战。最近，世卫组织认可了其中一些新方法，并以折扣价提供给高负担国家的公共卫生部门采购。此外，国际和国家实验室合作伙伴和捐助者目前正在评估其他新的诊断方法，这些方法将允许在护理点进行进一步和更快速的检测。虽然一些技术简单，但其他技术要求复杂，因此，重要的是要仔细确定如何将这些新的检测方法联系起来，并将其纳入国家的国家诊断算法中。最后，这些方法的成功实施取决于国际实验室界的重要伙伴关系，并确保每个国家的实验室网络都具有适当的质量保证计划。
