ORGANIZATION OF

1
ORGANIZATION OF TB LABORATORY SERVICES
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• Role of Laboratory in NTP?
• Estimation of demand of laboratoryservices for
  NTP
• Issues to be taken into account forsetting-up
  the laboratory networkfor NTP
• Set-up of different levels of laboratoriesfor
  NTP
• Mechanism for continued improvementof the
  services

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ROLE OF LABORATORY IN THENATIONAL TB CONTROL
PROGRAMME

• Definitive diagnosis detection of infectious
  sources (case-finding)
• Follow-up of patients response totreatment
• Participation in TB surveillancenotification
  (/prevalence) of TB DRS
• Assist in selecting effective treatment regimens

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• Information requiring to estimate demand of
• smear microscopy and the laboratories
• Population 10,000,000
• Newly registered smear positive casesnew
  retreatment cases (6,5001300) 7,800
• Smear positive rate among suspects 10
• Minimum number of smears for diagnosis 3
• Minimum number of smears for follow-up
  3X2smear positive/negative cases
• Optimum number of smears per day perworker
  (peripheral center) 10 / 15 rural
  population, administrative division,geography

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Estimation of smear microscopy demand and
required number of diagnostic laboratories For
diagnosis (1/0.1) x 7,800 x 3 234,000 For
follow-up smear positive cases, 7,800 x 3 x
2 46,800 smear negative cases, 2,600 x 6
15,600 Total smears required 296,400 If
optimum No of smears per day is 10 2,500
smears per year, so need 119If optimum
No of smears per day is 15 3,750 smears per
year, so need 79 Population covered
by a center (or worker) 10,000,000 / 119
84,000 10,000,000 / 79 127,000
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• ISSUES TO BE TAKEN INTO ACCOUNT IN
• SETTING UP LORATORY NETWORK FOR
• TB CONTROL PROGRAMME
• Reflect the local demands
• Accessible to entire population
• Relationship with NTP functionally should
  beintegrated be reporting performance to NTP
• Implement training and EQA (supervision)under
  NTP administration
• Provide all the affordable services by
  developinggood referral system
• Standard procedures must be carefullyselected
  according to the programme policyand development

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SETTING UP TB LABORATORY NETWORK Integration
into NTP desirable but expensive, fragile to
politicalcommitment health sector reform
(not sustainable) Integration into general
public health laboratory network lack of good
relationship with NTP (requires good
coordination to make them report and
implement training/EQA under NTP) Setting up
NRL?PL PL?IL ?NRL
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Classification of the different levels of
laboratory

• Administrative (jurisdictional) division
• Geography/ population coverage/ rural
  population
• Activities mandated microscopy culture/ID DST
• No. specimens examining per day
• (4) No. staff and their types of work
• (only TB or TBother works)
• (5) Laboratory facility and equipment

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PHERIPHERAL LABORATORY
Location Peripheral TB dispensary(center)
Health Center District Hospitals
1st Referral Hospitals Services
Sputum collection Z-N smear
microscopy Managerial Recording/reporting
Slides keeping for
EQA Manpower/workload 1(2) worker(s)
gt2-3 / lt20 smears per day Covering
population 100-200k
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INTERMEDIATE LABORATORY
Location Regional (TB) Health Institutions
including hospitals Services to
clinics FM/ZN smear microscopy
Culture / ID of MTB referral
services Supports to PLs Supply of
reagents/materials for smear
microscopy Training
Supervision EQA of smear microscopy Manpower
2-3 workers (only for TB works) Covering
population 500-1,500k
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TB LABORATORY NETWORK(fully integrated into NTP)
Peripheral (multipurpose) laboratories
TB Clinic or TB Dispensaries
PERIPHERAL LEVEL
Supplies Supervision EQA
Reports/ Referral services
Supervisory teams
INTERMEDIATE (REGIONAL/ PROVINCIAL) LEVEL
Intermediate laboratories
TB Center/ TB Unit/Ward
Reports/ Referral services
Supplies Supervision EQA
Central supervisory team
CENTRAL (NATIONAL) LEVEL
National reference laboratory
National TB Control Center
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TB LABORATORY NETWORK (separated from NTP)
TB Clinic in Health Institutions
Peripheral multipurpose laboratories
PERIPHERAL LEVEL
Supplies Supervision EQA
Reports/ Referral services
Supervisory teams
Laboratory coordinator
INTERMEDIATE (REGIONAL/ PROVINCIAL) LEVEL
TB Unit/ward In Health Institutions
Intermediate (multipurpose) laboratories
Supplies Supervision EQA
Reports/ Referral services
Central supervisory team
Laboratory coordinator
CENTRAL (NATIONAL) LEVEL
Central reference laboratory
National TB Control Center
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TB LABORATORY SPACE DESIGN BY LEVELS
Room
Functional Space
sections Smear microscopy Peripheral 1
(specimen reception/ laboratory
smear prep./stain./
microscopy/recording) Intermediate
1-2 Smear microscopy laboratory
(3) Culture Sterilisation/washing
Microscopy National Media
preparation reference
4-5 Culture laboratory Sterilisation
Storage