National Tuberculosis Reference Laboratory

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National Tuberculosis Reference Laboratory

• NHLS TB Laboratory
• MDR/XDR-TB

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Long Term Objectives

• Establish a NTBRL
• Finding/developing more appropriate diagnostic
  tools for South Africa
• Ongoing Surveillance and Reporting
• Research

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Medium Term Objectives

• Appoint Head of NTBRL
• Standardise all TB laboratory methodologies
• Quality management
• Internal
• Nationally

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Short Term Objectives

• Better liaison and communication with NTP,
  provincial service providers and support for TB
  advocacy activities and NGOs
• Improvement of TATs
• Training

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Turn Around Times

• Transport coverage
• Couriers
• in-house
• Intra-laboratory
• Extended hours
• Indicators
• extended laboratories
• Auto faxing
• SMS
• Accreditation type Corrective Action Sheets
• Monitoring
• Reporting formats

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What are we doing about MDR-TB and XDR-TB
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DRS
T

• MDR-TB
• INH Rif
• XDR-TB

All M. tuberculosis
MDR-TB
FQ
INJT
XDR-TB
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MDR Tuberculosis

• Resistance to INH Rifampicin
• Due to selective pressure with non-adherence
• Person to person transmission possible
• Treating with second line drugs
• Treatment extended to 24 months
• Less effective than first line
• Toxicity increase
• Expensive (gt100x)

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DNASTRIP Technology

• DNASTRIP Technology HAIN LIFESCIENCE

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Rifampicin resistance region of the rpoB- and
katG-gene
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FASTPlaque-Response
FASTPlaque-Response assay procedure
Sputum collection
Specimen processing (NALC-NaOH)
o/n incubation rifampicin

Interpretation of results



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How do we manage MDR XDR

• FIND Demonstration project
• PCR
• Plaque assay
• Validations
• Gauteng Hospitals
• Heat inactivated sputa
• Contaminants
• Special Cases
• CLINICAL CONTRIBUTION

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Gauteng proposed flowchart for PCR diagnosis
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Quality Assurance

• SOPs
• NICD EQA Proficiency Testing
• National Blind Re-checking Programme
• EQA for Culture and Drug Susceptibility Testing
• Indicators
• Accreditation/Laboratory Check Lists
• Training

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Challenges

• Human Resources
• Medical Technologists
• Medical Technicians
• Medical scientists
• Pathologists
• Logistics
• Easy part has been done
• DW and interfaces

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Points to Consider

• Case Finding by Culture
• Routine DST
• Designate one Provincial DST Coordinator
• Use of new diagnostics
• Improve Infection Control
• Contact Tracing
• Drug Resistance survey and Surveillance
• Improve Laboratory capacity
• Improve Laboratory EQA

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THANK YOU