GLOBAL HEALTH
Building TB Testing Capacity in Sierra Leone
By Shirematee Baboolal, PhD, consultant
In Sierra Leone, tuberculosis exacts a
heavy burden. In 2018 alone, there were
more than 17,000 notified cases of the
disease in a country with a population of
less than 8 million.
Since 2016, APHL has engaged with
the country’s Ministry of Health and
Sanitation to provide technical assistance
to the National TB Reference Laboratory
(NTRL) to build its TB testing capacity
for culture and drug sensitivity testing
(DST). Initially this capacity was limited.
In 2016 the NTRL was still a new entity
with uncompleted facilities. Formed
in 2014 under the country’s National
Tuberculosis Program, it performed only
acid fast bacilli smear microscopy using
the Ziehl-Neelson stain and GeneXpert
MTB/RIF. There was no facility available
for TB culture.
APHL began by modifying several small
rooms in the NTRL facility to perform
concentration of samples, solid culture
and line probe assay (LPA) (first line). It
leverage equipment available for LPA
and borrowed other equipment from the
Central Public Reference Laboratory to
train staff in molecular LPA.
AFRO SLIPTA checklist. At baseline, the
NTRL scored 57/275 points, which was
equivalent to zero stars under the rating
system. APHL trained NTRL staff to build
and sustain QMS in a step-wise manner
focusing on documentation, practice and
competency building. Though several key
areas remain to be addressed, a SLIPTA
audit in March 2019 showed significant
improvement with a score of 214/275,
equivalent to a three star rating.
With support from The Global Fund, a
modular laboratory was purchased with
all equipment and supplies for conducting
solid and liquid culture as well as DST
for first- and second-line drugs. This
facility was installed and commissioned
in February 2019. Training was conducted
on liquid culture and DST utilizing the BD
MGIT ™ TB System.
The laboratory can now conduct both
phenotypic culture and DST for several
drugs, including Streptomycin, Isoniazid
(0.1µg and 0.4µg), Rifampicin, Ethambutol
and Pyrazinamide, as well as LPA for first
and second line drugs. Second line drugs
for phenotypic testing will be added to the
test algorithm soon. n
Dr. Baboolal training staff in the new laboratory at NTRL
The following year, APHL introduced
quality management systems (QMS) with
a baseline assessment using the WHO/
APHL Publishes Guide to Lab Facility Construction, Renovation
By Palmira Mangae, specialist, Global Health
As part of its commitment to continuously improve
the public health laboratory system, APHL has
published new Laboratory Facility Construction
and Major Renovations Guidelines. Developed in
collaboration with HDR, Global Health Committee
members and consultants, this multifaceted
resource will help public health laboratory leaders
and stakeholders think comprehensively about
their facility’s needs, functions and sustainability.
Laboratory Facility
Construction and Major
Renovations Guidelines
The guide provides an overview of core activities
in the laboratory design process based on
lessons learned and best practices in laboratory
development and renovation. The information
helps laboratory teams walk through the design
process so that their construction project is a
success—not only in design, but operationally.
MAY 2019
For more information, please contact Palmira
For more information, please contact
Mangae
Palmira Mangae
®
20
LAB MATTERS Spring 2019
PublicHealthLabs
@APHL
APHL.org