STDs: Regaining Lost Ground, Improving the Future

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STDs Regaining Lost Ground, Improving the Future

• Clinical and Public Health Laboratories
• Sally Liska, DrPH
• San Francisco Public Health Lab

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Challenges Facing the Laboratory

• 1. Inadequate Number of Trained Staff
• Shortage of both bench-level and administrative
  laboratory staff
• 2. Diagnostic Reagents
• Cost of New Kits Molecular Diagnostics
  (amplified kits) are available but cost almost
  double the more traditional test methods
• Availability Some lab reagents are no longer
  manufactured.

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Staffing

• 1. Shortage of Clinical Laboratory Scientists in
  both hospital and public health laboratories.
• Highest staff vacancy rate in hospital labs in
  over a decade
• 2. Shortage of Lab Administrators
• 7 of 38 PH Labs in Calif have acting, off-site
  or no lab director

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Laboratory Diagnostics - 1

• 1.Good News Amplified methods are now
  commercially available for the detection of
  Chlamydia and Gonorrhea.
• 2. Bad News Less than half the STD testing
  utilizes these more sensitive methods (e.g.
  PCR).
• Only 35 of the GC and CT testing done in Calif
  in 2000 used amplified methods.

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Laboratory Diagnostics -2

• Lack of Some Diagnostic Reagents
• 1. Manufacture of Direct FA reagent for
  detection of primary syphilis has been
  discontinued.
• 2. Consolidation of commercial suppliers has
  led to decrease in number and variety of lab
  reagents (e.g. Difco and BBL).

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Points to Consider

• 1. Encourage laboratories to utilize nucleic acid
  amplification methods (LCR, PCR, SDA, TMS) to
  detect chlamydia and gonorrhea.
• 2. Investigate possibility of subsidizing
  commercial manufacturers or having government
  produce diagnostic reagents.