IRCCS San Raffaele Scientific Institute, Milan, Italy.
National Tuberculosis Program, Ouagadougou, Burkina Faso.
BMC Infect Dis. 2021 Apr 13;21(1):346. doi: 10.1186/s12879-021-06012-y.
The laboratory plays a critical role in tuberculosis (TB) control by providing testing for diagnosis, treatment monitoring, and surveillance at each level of the health care system. Weak accessibility to TB diagnosric services still represents a big concern in many limited resources' countries. Here we report the experience of Burkina Faso in implementing a comprehensive intervention packages to strengthen TB laboratory capacity and diagnostic accessibility.
The intervention lasted from October 2016 to December 2018 and focused on two main areas: i) development of strategic documents and policies; ii) implementation of TB diagnostic technology. National TB laboratory data were collected between 2016 and 2018 and evaluated according to five programmatic TB laboratory indicators: i) Percentage of notified new and relapse TB cases with bacteriological confirmation; ii) Percentage of notified new and relapse TB cases tested by Xpert MTB/RIF; iii) Percentage of notified, bacteriologically confirmed TB cases with a drug susceptibility testing (DST) result for rifampin; iv) Percentage of notified MDR-TB cases on the estimated number of MDR-TB cases; v) The ration between the number of smear microscopy and Xpert MTB/RIF tests. We compared these indicators between a 1 year (2016-2017) and 2 years (2016-2018) timeframe.
From 2016 to 2018, the percentage of bacteriologically confirmed cases increased from 67 to 71%. The percentage of new and relapse TB cases notified tested by Xpert MTB/RIF increased from 18% in 2016 to 46% in 2018 and the percentage of bacteriologically confirmed cases with an available DST result for rifampicin increased from 27% in 2016 to 66% in 2018.. The percentage of notified MDR-TB cases on the estimated number of MDR-TB cases in 2018 increased from 43% in 2016 to 78% in 2018. In 2018, the ratio between the number of smear microscopy and Xpert MTB/RIF tests decreased from 53% in 2016 to 21% in 2018.
We demonstrated that the implementation of a comprehensive package of laboratory strengthening interventions led to a significant improvement of all indicators. External technical assistance played a key role in speeding up the TB laboratory system improvement process.
实验室在结核病（TB）控制中起着至关重要的作用，通过在医疗保健系统的各个层面提供诊断检测、治疗监测和监测。在许多资源有限的国家，TB 诊断服务的获取仍然是一个巨大的挑战。在这里，我们报告布基纳法索在实施一项全面的干预计划以加强结核病实验室能力和诊断可及性方面的经验。
该干预措施从 2016 年 10 月持续到 2018 年 12 月，主要集中在两个领域：i）制定战略文件和政策；ii）实施 TB 诊断技术。2016 年至 2018 年期间收集了国家结核病实验室数据，并根据五个规划结核病实验室指标进行了评估：i）有细菌学确认的新发病例和复发病例的通知比例；ii）新发病例和复发病例中接受 Xpert MTB/RIF 检测的通知比例；iii）有药敏试验（DST）结果的通知、细菌学确认的 TB 病例中对利福平的耐药比例；iv）通知的耐多药结核病（MDR-TB）病例数与估计的 MDR-TB 病例数的比例；v）痰涂片显微镜检查和 Xpert MTB/RIF 检查数量之比。我们比较了 2016-2017 年和 2016-2018 年这两个时间段的这些指标。
2016 年至 2018 年，细菌学确诊病例的比例从 67%增加到 71%。新发病例和复发病例中接受 Xpert MTB/RIF 检测的通知比例从 2016 年的 18%增加到 2018 年的 46%，有药敏试验结果的细菌学确诊病例中对利福平的耐药比例从 2016 年的 27%增加到 2018 年的 66%。2018 年，估计的耐多药结核病病例数中通知的耐多药结核病病例数的比例从 2016 年的 43%增加到 2018 年的 78%。2018 年，痰涂片显微镜检查和 Xpert MTB/RIF 检查数量之比从 2016 年的 53%下降到 2018 年的 21%。
我们证明，实施综合实验室强化干预计划可显著改善所有指标。外部技术援助在加快结核病实验室系统改进进程方面发挥了关键作用。
