FIND, Cape Town, South Africa.
LLamasoft Inc., St. Ann Arbor, MI, United States of America.
PLoS One. 2020 Jun 3;15(6):e0233620. doi: 10.1371/journal.pone.0233620. eCollection 2020.
To reach WHO End tuberculosis (TB) targets, countries need a quality-assured laboratory network equipped with rapid diagnostics for tuberculosis diagnosis and drug susceptibility testing. Diagnostic network analysis aims to inform instrument placement, sample referral, staffing, geographical prioritization, integration of testing enabling targeted investments and programming to meet priority needs.
Supply chain modelling and optimization software was used to map Lesotho's TB diagnostic network using available data sources, including laboratory and programme reports and health and demographic surveys. Various scenarios were analysed, including current network configuration and inclusion of additional GeneXpert and/or point of care instruments. Different levels of estimated demand for testing services were modelled (current [30,000 tests/year], intermediate [41,000 tests/year] and total demand needed to find all TB cases [88,000 tests/year]).
Lesotho's GeneXpert capacity is largely well-located but under-utilized (19/24 sites use under 50% capacity). The network has sufficient capacity to meet current and near-future demand and 70% of estimated total demand. Relocation of 13 existing instruments would deliver equivalent access to services, maintain turnaround time and reduce costs compared with planned procurement of 7 more instruments. Gaps exist in linking people with positive symptom screens to testing; closing this gap would require extra 11,000 tests per year and result in 1000 additional TB patients being treated. Closing the gap in linking diagnosed patients to treatment would result in a further 629 patients being treated. Scale up of capacity to meet total demand will be best achieved using a point-of-care platform in addition to the existing GeneXpert footprint.
Analysis of TB diagnostic networks highlighted key gaps and opportunities to optimize services. Network mapping and optimization should be considered an integral part of strategic planning. By building efficient and patient-centred diagnostic networks, countries will be better equipped to meet End TB targets.
为了实现世界卫生组织（WHO）终结结核病（TB）的目标，各国需要建立一个质量有保证的实验室网络，配备用于结核病诊断和药敏检测的快速诊断工具。诊断网络分析旨在为仪器配置、样本转介、人员配备、地理优先级划分、检测能力整合提供信息，以进行有针对性的投资和规划，满足优先需求。
利用供应链建模和优化软件，根据现有的数据源（包括实验室和项目报告以及人口与健康调查），对莱索托的结核病诊断网络进行了映射。分析了各种情景，包括当前网络配置以及纳入额外的 GeneXpert 和/或即时检测工具的情况。对不同水平的检测服务需求进行了建模（当前需求[30000 次/年]、中期需求[41000 次/年]和发现所有结核病病例所需的总需求[88000 次/年]）。
莱索托的 GeneXpert 能力布局合理，但利用率低（24 个站点中有 19 个站点的利用率不足 50%）。该网络有足够的能力满足当前和近期需求以及 70%的估计总需求。与计划采购 7 台新仪器相比，重新配置 13 台现有仪器将提供同等的服务获取机会，保持周转时间，并降低成本。在将有阳性症状筛查的人联系到检测方面存在差距；每年额外增加 11000 次检测，将使 1000 名额外的结核病患者得到治疗，可填补这一差距。将确诊患者与治疗联系起来的差距将使另外 629 名患者得到治疗。为了满足总需求，增加容量最好采用即时检测平台，同时利用现有的 GeneXpert 网络。
结核病诊断网络分析突出了优化服务的关键差距和机会。网络映射和优化应被视为战略规划的一个组成部分。通过建立高效和以患者为中心的诊断网络，各国将更好地实现终结结核病的目标。
