re-organization of the tb laboratory network in belarus...davyd-gorodok 1,531 6 22 1.4 drogichin...
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Re-organization of the TB laboratory network
in Belarus
Aksana Zalutskaya Head of the National Reference Laboratory Republican Scientific and Practical Centre
for Pulmonology and Tuberculosis Minsk, Belarus
TB rate
Number of
patients
per 100 000
Incidence 3 196 34.5
Prevalence 7 391 78.1
Mortality 445 4.7
TB burden in the Republic of Belarus, 2014
Trends in TB incidence in Belarus
New cases and relapses New cases
13.1 9.2
11.2
18.4 23.0 24.0 23.3
32.0 38.2
35.8 36.6
42.0 47.9
60.2 59.2
66.4 69.4
64.9
4.8
5.0
6.3 8.7
10.8 7.7 8.8
10.7 9.3 11.7 15.9 16.7
22.4
25.7 27.0 32.9 33.8 32.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Previously treated
New cases
Trends in MDR-TB proportions in Belarus
The National Reference Laboratory (2007)
Re-organization of the laboratory network: The vision
• Network of laboratories performing tests for tuberculosis efficiently and high-quality while assuring biosafety
Analysis of the situation : Brest Oblast, 2007 (1)
Number of
cultures
Number of
cultures
per day
Number of
isolates
Positivity rate,
%
Number of DST
Laboratories
City of Brest 25,116 100 2169 8.6 650
Baranovichi 11,508 46 1436 12.5 613
“Verkhovichi" 3,731 15 1676 44.9 404
Pinsk 14,393 58 305 2.1 271
“Molotkovichi" 3,473 14 557 16.0 224 Culturing points
Ruzhany 515 2 0 0.0
Bereza 5,768 23 19 0.3
Beloozersk 2,759 11 12 0.4
Gantsevichi 3,608 14 15 0.4
Davyd-Gorodok 1,531 6 22 1.4
Drogichin 3,400 14 30 0.9
Ivanovo 4,263 17 118 2.8
Ivatsevichi 4,074 16 11 0.3
Kobrin 2,695 11 13 0.5
Luninets 4,900 20 200 4.1
Pruzhany 3,997 16 34 0.9
Analysis of the situation : Brest Oblast, 2007 (2)
Laboratory equipment
Year Laboratories Source
2008 Basic laboratory equipment (BSC class II, centrifuges 3000 g with safety buckets, incubators, microscopes, autoclaves, electronic balances, air sterilizers, etc.)
29 labs GF, FIND
(2012-2014)
2009 ВАСТЕС MGIT 960 8 labs Level III GF
2011 LPA
8 labs Level III
GF
2012-2013 GeneXpert 15 (8 labs level III 7 labs level II)
GF, TBXpert
2016 (GF Concept
Note)
GeneXpert
14
Minsk
Grodno
Brest
Vitebsk
Mogilev
Gomel’
TB laboratory network before re-organization
RRL
Oblast TB lab
Rayon TB lab
Culturing point
Grodno
Minsk
Vitebsk
Brest
Minsk
Penitentiary Lab
Gomel’
NRL
Level III
Level II
Mogilev
TB laboratory network after re-organization
NRL
Level III (7)
Level II (21)
Level I (150)
Stockholm
SRL
Microscopy, culture, mycobacteria identification, 1 and 2 line DST, ВАСТЕС, LPA, GeneXpert
Microscopy, culture, GeneXpert
Microscopy
TB Laboratory network, 2015
The guidelines
Guideline for the laboratory diagnostics of TB
Health regulations for TB institutions
GeneXpert AFB Microscopy Culture
Diagnostic specimen
MTB susceptible to
R (R, H)
MTB-
MTB- AFB+
AFB- Result Result Result
DST I line (ВАСТЕС MGIT960)
LPA
MTB+ resistant to R
Resistant to R, H
MTB+
LPA II line
Treatment as Category I
Risk groups
Susceptible to R, H
Result
DST I, II lines, Z (ВАСТЕС MGIT960)
Resistant to R, H
MDR-TB consilium, treatment for MDR-TB,
isolation
MDR-TB consilium, correction of the
chemotherapy regimen
Treatment as Category I
MDR-TB consilium, treatment for MDR-TB,
isolation
DST I, II lines, Z (ВАСТЕС MGIT960)
DST I, II lines (LJ)
If necessary, DST II line, Z
Algorithm of TB laboratory diagnosis with the use of rapid techniques
0
10
20
30
40
50
60
70
80
90
100
DA DB DC DD DE DF DG DH total
0
10
20
30
40
50
60
70
80
90
100
DA DB DC DD DE DF DG DH total
EQA of the DST (WHO/SRL strain panel), 2014 (1)
Isoniazid Rifampicin
Streptomycin Ethambutol
0
10
20
30
40
50
60
70
80
90
100
DA DB DC DD DE DF DG DH total
0
10
20
30
40
50
60
70
80
90
100
DA DB DC DD DE DF DG DH total
Amikacin Kanamycin
Ofloxacin Capreomycin
0
10
20
30
40
50
60
70
80
90
100
DA DB DC DD DE DF DG DH total
0
10
20
30
40
50
60
70
80
90
100
DA DB DC DD DE DF DG DH total
0
10
20
30
40
50
60
70
80
90
100
DA DB DC DD DE DF DG DH total
0
10
20
30
40
50
60
70
80
90
100
DA DB DC DD DE DF DG DH total
EQA of the DST (WHO/SRL strain panel), 2014 (2)
Infection control: Assessment of the laboratory layouts
Culture In
cub
ato
rs
Autoclave
Media
DST
Microscopy
Consu- mables
Person- nel
Samples receiving
Culture Autoclave
Media
Microscopy
Ofis Person-
nel Incu-
bators
Before
After
Chemicals Consu- mables
The National trainers (TB specialists) team (2012-2014)
National TB register: Laboratory component
Re-organization’s outputs: The efficiency of culture
Positivity rate, %
Cultures
Isolates
11,612,0
14,2
12,712,3
0
8
16
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
20132014
0
100000
200000
300000
400000
500000
600000
700000
800000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Re-organization’s outputs: Positivity rate of new TB cases, %
43.8
20.2
64.7
39.8
0
10
20
30
40
50
60
70
80
90
100
2006
2014
Culture Smear
National strategic plan for the prevention and control of TB and MDR-TB
in the Republic of Belarus in 2015-2020
Additional indicators
• Proportion of patients in who MDR-TB was diagnosed by molecular genetic methods out of all smear-positive patients with MDR-TB reported within a year – 95%
• Median delay of confirming MDR-TB (difference between the time of TB reporting and finding MDR-TB) in smear-positive patients – 7 days
Thank you for your attention