strengthening laboratory systems for mdrtb
TRANSCRIPT
Strengthening Laboratory
Systems for MDRTB
Strengthening Laboratory
Systems for MDRTBJohn Ridderhof, DrPH
Chair, Subgroup on Laboratory Capacity Strengthening
Associate Director for Laboratory Science
National Center for Prevention, Detection and Control of Infectious Diseases
CCID/CDC
John Ridderhof, DrPH
Chair, Subgroup on Laboratory Capacity Strengthening
Associate Director for Laboratory Science
National Center for Prevention, Detection and Control of Infectious Diseases
CCID/CDC
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Current challenges/MDRCurrent challenges/MDR
• 5-10%% MDR cases diagnosed
• Difficulties in implementing culture and DST
• Quality of culture and DST is often questionable
• Second line drug (SLD) testing primarily
restricted to SRLs
• 5-10%% MDR cases diagnosed
• Difficulties in implementing culture and DST
• Quality of culture and DST is often questionable
• Second line drug (SLD) testing primarily
restricted to SRLs
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Key MessagesKey Messages
• Strengthen microscopy and culture and implement new methods
• Better test performance in laboratories where quality systems are required
• Scale up of laboratory capacity will require initiatives to integrate services
• The laboratory is a system and new diagnostics will require strong systems
• Strengthen microscopy and culture and implement new methods
• Better test performance in laboratories where quality systems are required
• Scale up of laboratory capacity will require initiatives to integrate services
• The laboratory is a system and new diagnostics will require strong systems
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Stop TB Partnership
Workgroups
Stop TB Partnership
Workgroups
• DOTS Expansion WG
� Subgroup on Laboratory Capacity Strengthening (SLCS)
• WG on New TB diagnostics
• TB/HIV WG
• MDRTB WG
• WG on New TB Drugs
• WG on New TB Vaccines
• Advocacy, Communication, and Social Mobilization WG
• DOTS Expansion WG
� Subgroup on Laboratory Capacity Strengthening (SLCS)
• WG on New TB diagnostics
• TB/HIV WG
• MDRTB WG
• WG on New TB Drugs
• WG on New TB Vaccines
• Advocacy, Communication, and Social Mobilization WG
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Coordinating CentreAntwerp, Belgium
Network of 26 Supranational Laboratories
National/Regional Reference Laboratories
Panel of 30 coded isolates
Panel of 20 coded isolates
Sample of isolates for rechecking
(DRS/DOTS-Plus)
Initial Assessment
Ongoing TA
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Acceleration of SLCS activitiesAcceleration of SLCS activities
• Formed in 2002, Initial focus on SRLN has evolved to general capacity building
• Development of technical guidance transitioned from volunteer efforts to structured consensus process with partners
• Core group formed, meetings in March and July 2007
• USAID funding for business plan development
• Increase in technical workgroups
• Formed in 2002, Initial focus on SRLN has evolved to general capacity building
• Development of technical guidance transitioned from volunteer efforts to structured consensus process with partners
• Core group formed, meetings in March and July 2007
• USAID funding for business plan development
• Increase in technical workgroups
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SLCS core groupSLCS core group
• Chair
• WHO Secretariat
• IUATLD
• FIND
• CDC
• Patient Community
• NTP/NRL
• NTP/NRL
• SRL
• SRL
• Observers
• Liaisons with other WG
• Chair
• WHO Secretariat
• IUATLD
• FIND
• CDC
• Patient Community
• NTP/NRL
• NTP/NRL
• SRL
• SRL
• Observers
• Liaisons with other WG
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Technical Workgroups/ConsultationsTechnical Workgroups/Consultations
• Use of liquid culture methods (March 07)
• Interim policy guidance for second line drug
(SLD) testing (July 07)
• Technical procedures for SLD testing (August
07)
• Use of liquid culture methods (March 07)
• Interim policy guidance for second line drug
(SLD) testing (July 07)
• Technical procedures for SLD testing (August
07)
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Development of business planDevelopment of business plan
• Consultation with committee of core group
(January 07)
• Review and input of core group/development of
global estimates (March 07)
• Refinement of organizational structure (July 07)
• Consultation with committee of core group
(January 07)
• Review and input of core group/development of
global estimates (March 07)
• Refinement of organizational structure (July 07)
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Why a Global Network of sharing knowledge,
guidance, and assurance?
Why a Global Network of sharing knowledge,
guidance, and assurance?
• The laboratory systems must address quality and productivity to make an effective and efficient increase in capacity
• The sheer number of laboratory personnel on the global level (200-400,000) calls for new and novel ways of disseminating knowledge
• The laboratory system and donors require far stronger coordination and guidance and assurance on what constitutes appropriate laboratory practice
• More and better focused advocacy for the cause of laboratory strengthening
• The laboratory systems must address quality and productivity to make an effective and efficient increase in capacity
• The sheer number of laboratory personnel on the global level (200-400,000) calls for new and novel ways of disseminating knowledge
• The laboratory system and donors require far stronger coordination and guidance and assurance on what constitutes appropriate laboratory practice
• More and better focused advocacy for the cause of laboratory strengthening
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Training MaterialsTraining Materials
GuidelinesGuidelines Programs/ReportsPrograms/Reports
Workshops/ConferencesWorkshops/Conferences
The US initiative in the 90The US initiative in the 90’’s to meet the challenge of MDRs to meet the challenge of MDR--TBTB““The Laboratory Makes a DifferenceThe Laboratory Makes a Difference””
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Required expansion of testing and fundingRequired expansion of testing and funding
2010 2012 2015
Required e
xpansion of
Culture capacity: fro
m 10 to 60
mln pa
# of tests required (mln) $ of funding
required (mln)
2500
2000
1500
1000
500
Required
expansi
on of Smear c
apacity
: from
80 to 20
0 mln p
a
To reach MDG targets, a global capacity gap of 120 mln smear and 50 mln culture tests must be addressed – in accordance to country-specific conditions and priorities. This requires $2,500 mln for investment funding, of which $900 mln is needed for urgent immediate requirements.
2008
Urg
en
t M
DG
Targ
et
200
150
100
50
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Strengthening the Global TB Laboratory NetworkStrengthening the Global TB Laboratory Network
Network will be an active facilitator of communication and provide various global infrastructure services including guidance, assurance and interface connection activities – all synchronized to be a coherent network service.
Network will be an active facilitator of communication and provide various global infrastructure services including guidance, assurance and interface connection activities – all synchronized to be a coherent network service.
~100.000 smear lab centers200.000-300.000 personnel
~8.000 advanced diagnostic centers40.000 – 50.000 personnel
150 National Reference Labs
70 SLCS Members
WHO Network Office
Knowledge Sharing:
- Coordination of provision of TA and training
- organizing meetings- Advanced communication technologies
- TB-Wiki; Knowledge Resource Network online
Interface Connection:
- Matchmaking of projects between countries and implementing partners
- manage stakeholders- Advocacy for lab funding- Other TB communities- Other disease networks
Assurance activities:
- coordination of EQA- specifications for equipment and machines
- Global accreditation system- Monitoring/evaluation
Guidance Activities:- lab manuals- 2nd line DST- Creation of training materials
- Recommendations for funding strategy
- National Roadmap advice
Exemplary activities of the Network
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Priority Activities at Global LevelPriority Activities at Global Level
• International training for 100 “implementation”consultants
• New strategies for knowledge sharing
• Drug resistance surveillance funding gap
• Equipment and material specifications
• Training materials for culture and DST
• Guidance for second line drug (SLD) testing
• Update laboratory manuals (WHO/IUATLD/CDC)
• Develop Accreditation for TB laboratories
• National “roadmaps” for countries/technical partner
• Office for coordination of Laboratory Technical Assistance
• International training for 100 “implementation”consultants
• New strategies for knowledge sharing
• Drug resistance surveillance funding gap
• Equipment and material specifications
• Training materials for culture and DST
• Guidance for second line drug (SLD) testing
• Update laboratory manuals (WHO/IUATLD/CDC)
• Develop Accreditation for TB laboratories
• National “roadmaps” for countries/technical partner
• Office for coordination of Laboratory Technical Assistance
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Key points from planning processKey points from planning process
• Scale up of technical assistance (TA) through multiple partners requires greater coordination, different models of support, and increased tool development
• Network core will be housed in WHO with project management involving partners
• Increase senior and midlevel laboratory consultants
• Scale up of technical assistance (TA) through multiple partners requires greater coordination, different models of support, and increased tool development
• Network core will be housed in WHO with project management involving partners
• Increase senior and midlevel laboratory consultants
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Next Steps/PrioritiesNext Steps/Priorities
• Refine business plan based on input from key StopTB stakeholders at Capetown
• Meet with multiple donors to seek sustained funding support
• Promote advocacy for laboratory programs/capacity building
• Promote partner participation/contributions through increased SLCS communications and coordination
• Refine business plan based on input from key StopTB stakeholders at Capetown
• Meet with multiple donors to seek sustained funding support
• Promote advocacy for laboratory programs/capacity building
• Promote partner participation/contributions through increased SLCS communications and coordination
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AcknowledgementsAcknowledgements
• Armand Van Deun
• Karin Weyer
• Rick O'Brien
• Chris Gilpin
• Abigail Wright
• Mohamed Aziz
• Armand Van Deun
• Karin Weyer
• Rick O'Brien
• Chris Gilpin
• Abigail Wright
• Mohamed Aziz
• Moses Joloba
• Kai Man Kam
• Francis Drobniewski
• Lucia Barrera
• Tom Shinnick
• Case Gordon
• Peer Ederer
• Moses Joloba
• Kai Man Kam
• Francis Drobniewski
• Lucia Barrera
• Tom Shinnick
• Case Gordon
• Peer Ederer