Achievements of the Supranational Reference Laboratory Network 19942009

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Achievements of the Supranational Reference
Laboratory Network1994-2009

• Armand Van Deun, MD, PhD
• The Union

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SRL network current status
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Network

• Little change since 1994
• Very few in low-income
• Map and database

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http//glitblabs.blogspot.com/
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Selection and certification

• Original group historical links WHO/Union
• later too little formal needs, opportunities,
  ....
• minimal requirements
• participate in rounds
• support at least 2 countries
• TOR between country and SRL
• FAQ how do we become a SRL?
• unofficial status, no funds yet much desired
• certification process ill-defined
• assessment visit
• good scores in min. 2 successive rounds

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ACHIEVEMENTS
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Proficiency testing rounds

• Mainly standardised use of DST (first-line)
• annual rounds of proficiency testing among SRL
• initial discordances
• soon resolved uniformisation techniques
• ? high agreement among established SRL

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Proficiency testing (2)

• Started second-line drug proficiency testing
• rounds 14 15
• looks quite good
• Cm more problematic (some labs)
• Km, Ak, Ofx at par with FLD
• but so far few resistant strains included

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Proficiency testing (3)

• Regional networks and PT
• European Task Force L. American network WPRO
• Individual links SRL- NRL
• incomplete and unclear
• recent survey 19/51 countries in Africa report 1
  or more links
• SRLs report 96 country links (duplicates
  excluded) variation
• functionality ? mainly DST and DRS
• Ad hoc links DR surveys
• panels
• limited TA and rechecking

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Research

• Has been very limited
• questions not lacking
• RMP borderline strains
• obvious problem from rounds
• 9 volunteer SRL special panel of strains
• particular mutations MICs close to the
  breakpoint
• systematically missed by BACTEC
• importance ? needs further research

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Limitations
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Felt deficiencies

• Few SRL in the south (Africa! Francophone!)
• Links organisation and continuity
• Scope of the activities
• support to existing / candidate SRL
• SRL not supporting other countries
• support to countries often too narrow
• operational research needs not addressed

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Obstacles

• Lack of a clear plan
• Lack of TOR / enforcement
• Lack of funding
• salaries additional staff needed to provide
  support
• larger scale panel production, rounds conduct
• TA visits, meetings
• ad hoc operational research
• Lack of suitable SRL (candidates) ?
• low-income in-country needs still huge
• industrialised appropriate expertise language