Abstract
Setting: The Uganda National Tuberculosis Reference Laboratory (NTRL) in Kampala. Objective: The proportion of poor quality specimens received for drug susceptibility testing (DST) at the NTRL and factors contributing to poor specimen quality were assessed. Design: A cross-sectional study was conducted of sputum samples received at the NTRL from patients at high risk for multi-drug-resistant tuberculosis (MDR TB) during July-October 2013. Demographic, clinical, and bacte-riological data were abstracted from laboratory records. A poor quality sample failed to meet any one of four criteria: ≥3 milliliter (ml) volume, delivered within 72 hours, triple packaged, and non-salivary appearance. Results: Overall, 365 (64%) of 556 samples were of poor quality; 89 (16%) were not triple packaged, 44 (8%) were <3 mls, 164 (30%) were not delivered on time, and 215 (39%) were salivary in appearance. Poor quality specimens were more likely to be collected during the eighth month of TB treatment (OR = 2.5, CI = 1.2 - 5.1), from the East or Northeast zones (OR = 2.2, CI = 1.1 - 4.8), and from patients who previously defaulted from treatment (OR = 1.9, CI = 1.1 - 3.2). Conclusion: The majority of sputum samples had poor quality. Additional efforts are needed to improve quality of samples collected at the end of treatment, from East and Northeast zones, and from patients who had previously defaulted.
Highlights
Worldwide, the burden of multidrug-resistant tuberculosis (MDR TB), which is defined as TB resistant to at least isoniazid and rifampicin, is estimated to be 3.6% among newly-diagnosed TB cases and 20% among retreatment cases [1]
Of the 556 samples included in the study, most were from patients who were male (69%), aged 31 - 40 years (30%), had failed treatment (38%) and were from regional referral hospitals (32%) in the North and Northwest zones (30%) (Table 1, Figure 2)
Any sample which did not meet any of the above criteria was defined as a poor quality sample. In this cross-sectional study examining the frequency of and factors related to poor quality specimens in Uganda, we found that nearly two-thirds of the samples received at the national referral laboratory for culture and drug-susceptibility testing (DST) were of poor quality based on four criteria, including volume, timeliness, packaging, and appearance
Summary
The burden of multidrug-resistant tuberculosis (MDR TB), which is defined as TB resistant to at least isoniazid and rifampicin, is estimated to be 3.6% among newly-diagnosed TB cases and 20% among retreatment cases [1]. To ensure early detection of MDR TB and rapid initiation of measures to control its transmission, the World Health Organization (WHO) recommends routine testing among retreatment TB cases to rule out MDR TB [2]. To improve DST services and MDR TB detection rates in Uganda, a TB Specimen Referral System (TSRS) was developed in 2009 by the National TB and Leprosy Program (NTLP) and the National TB Reference Laboratory (NTRL) for patients at high risk of MDR TB. Within the TSRS, a sputum sample of at least 3 milliliters (mls) is collected by trained health care workers at local health facilities from all patients who are diagnosed with smear-positive TB and at high risk for MDR TB. Results are returned to their respective health facilities through the postal service [5]
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