Abstract
BackgroundTo reach WHO End tuberculosis (TB) targets, countries need a quality-assured laboratory network equipped with rapid diagnostics for tuberculosis diagnosis and drug susceptibility testing. Diagnostic network analysis aims to inform instrument placement, sample referral, staffing, geographical prioritization, integration of testing enabling targeted investments and programming to meet priority needs.MethodsSupply chain modelling and optimization software was used to map Lesotho’s TB diagnostic network using available data sources, including laboratory and programme reports and health and demographic surveys. Various scenarios were analysed, including current network configuration and inclusion of additional GeneXpert and/or point of care instruments. Different levels of estimated demand for testing services were modelled (current [30,000 tests/year], intermediate [41,000 tests/year] and total demand needed to find all TB cases [88,000 tests/year]).ResultsLesotho’s GeneXpert capacity is largely well-located but under-utilized (19/24 sites use under 50% capacity). The network has sufficient capacity to meet current and near-future demand and 70% of estimated total demand. Relocation of 13 existing instruments would deliver equivalent access to services, maintain turnaround time and reduce costs compared with planned procurement of 7 more instruments. Gaps exist in linking people with positive symptom screens to testing; closing this gap would require extra 11,000 tests per year and result in 1000 additional TB patients being treated. Closing the gap in linking diagnosed patients to treatment would result in a further 629 patients being treated. Scale up of capacity to meet total demand will be best achieved using a point-of-care platform in addition to the existing GeneXpert footprint.ConclusionsAnalysis of TB diagnostic networks highlighted key gaps and opportunities to optimize services. Network mapping and optimization should be considered an integral part of strategic planning. By building efficient and patient-centred diagnostic networks, countries will be better equipped to meet End TB targets.
Highlights
To reach World Health Organization (WHO) End tuberculosis (TB) targets, countries need a quality-assured laboratory network equipped with rapid diagnostics for tuberculosis diagnosis and drug susceptibility testing
The World Health Organization (WHO) End tuberculosis (TB) Strategy calls for increased access to diagnostic tools for rapid and accurate detection of TB, universal access to drug susceptibility testing (DST), and strengthened quality of laboratory services [1], measures that will be critical to reaching national and global TB control targets
With an increasing choice of TB diagnostics endorsed by WHO for use in low and middle income settings [2], countries must select products that are appropriate for their own contexts and disease burdens, and design diagnostic algorithms to enable expanded access [3]
Summary
The World Health Organization (WHO) End tuberculosis (TB) Strategy calls for increased access to diagnostic tools for rapid and accurate detection of TB, universal access to drug susceptibility testing (DST), and strengthened quality of laboratory services [1], measures that will be critical to reaching national and global TB control targets. The Ministry of Health (MOH) in Lesotho has rolled out the Xpert MTB/RIF test (Cepheid, Sunnyvale, CA, USA), a nucleic acid amplification test for the rapid diagnosis of TB and detection of rifampicin resistance. Access to Xpert MTB/RIF testing and linkage of diagnosed patients to care remains a challenge [7]. To reach WHO End tuberculosis (TB) targets, countries need a quality-assured laboratory network equipped with rapid diagnostics for tuberculosis diagnosis and drug susceptibility testing. Diagnostic network analysis aims to inform instrument placement, sample referral, staffing, geographical prioritization, integration of testing enabling targeted investments and programming to meet priority needs
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