Abstract
BackgroundThe increasing prevalence of drug-resistant tuberculosis and the threat of extensively-drug-resistant tuberculosis in HIV hotspots have made the detection and treatment of drug-resistant tuberculosis in the sub-Saharan Africa setting a global public health priority.ObjectiveWe sought to examine the impact and challenges of tuberculosis diagnostic capacity development for the detection of drug-resistant tuberculosis and bio-surveillance using a modular biosafety level 3 (BSL-3) laboratory in Nigeria.MethodIn 2010, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) programme, through the Institute of Human Virology at the University of Maryland in Baltimore, Maryland, United States, deployed a modular, BSL-3 laboratory to support the national tuberculosis programme in drug-resistant tuberculosis detection and bio-surveillance for effective tuberculosis prevention and control.ResultsFrom 2010 until present, sputum samples from 11 606 suspected cases in 33 states were screened for drug-resistant tuberculosis. Of those, 1500 (12.9%) had mono-resistant tuberculosis strains, and 459 (4.0%) cases had multidrug-resistant tuberculosis. Over the last four years, 133 scientists were trained in a train-the-trainer programme on advanced tuberculosis culture, drug susceptibility testing, line-probe assays and Xpert® MTB/RIF, in addition to safety operations for biosafety facilities. Power instability, running cost and seasonal dust are notable challenges to optimal performance and scale up.ConclusionMovable BSL-3 containment laboratories can be deployed to improve diagnostic capacity for drug-resistant tuberculosis and bio-surveillance in settings with limited resources.
Highlights
The increasing prevalence of drug-resistant tuberculosis and the threat of extensively-drug-resistant tuberculosis in HIV hotspots have made the detection and treatment of drug-resistant tuberculosis in the sub-Saharan Africa setting a global public health priority
Presumptive cases of multi-drug resistant (MDR) tuberculosis from different parts of the country went to the distant coastal city of Lagos for diagnosis and at the Nigerian Institute for Medical Research, which housed the only tuberculosis reference laboratory for a population of over 170 million
According to a 2011 WHO report on global tuberculosis control, two in 100 of the newly detected tuberculosis cases and nine in 100 of retreated cases in Nigeria were MDR tuberculosis.[4]
Summary
The increasing prevalence of drug-resistant tuberculosis and the threat of extensively-drug-resistant tuberculosis in HIV hotspots have made the detection and treatment of drug-resistant tuberculosis in the sub-Saharan Africa setting a global public health priority. The number of culture reference laboratories has risen to seven, yet they covered only 4% to 8% of the World Health Organization-recommended population target of one functioning culture laboratory per 500 000 to one million population.[3] According to a 2011 WHO report on global tuberculosis control, two in 100 of the newly detected tuberculosis cases and nine in 100 of retreated cases in Nigeria were MDR tuberculosis.[4] The National Tuberculosis and Leprosy Training Centre in Zaria has the largest tuberculosis referral center in northern Nigeria, with an average of 25–30 new smear-positive tuberculosis cases enrolled in treatment and care monthly; about 27% of the enrolled tuberculosis cases are co-infected with HIV.[5] In addition to the reference laboratory, the centre has a large outpatient clinic for the management of tuberculosis, HIV and leprosy. It has a modest inpatient facility, mainly for the treatment of MDR tuberculosis, with a 20-bed capacity and two isolation rooms
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