Abstract
Over the past 10 years, the Peruvian National Tuberculosis (TB) Program, the National Reference Laboratory (NRL), Socios en Salud, and US partners have worked to strengthen the national TB laboratory network to support treatment of multidrug-resistant TB. We review key lessons of this experience. The preparation phase involved establishing criteria for drug susceptibility testing (DST), selecting appropriate DST methods, projecting the quantity of DST and culture to ensure adequate supplies, creating biosafe laboratory facilities for DST, training laboratory personnel on methods, and validating DST methods at the NRL. Implementation involved training providers on DST indications, validating conventional and rapid first-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting. Monitoring included ongoing quality control and quality assurance procedures. Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation. Operational research guided laboratory scale-up and identified barriers to effective capacity building.
Highlights
TB incidence in Peru is among the highest in LatinAmerica, at 108.2/100,000 persons in 2005 (Table 1) [7]
We summarize the key lessons that may be relevant for other settings where multidrug-resistant TB (MDR TB) treatment is being planned or implemented
During 1990–2000, Peru implemented a model program based on the World Health Organization (WHO)–endorsed strategy of directly observed treatment, short course (DOTS) [12]
Summary
In the densely populated periphery of Lima, where half of all national cases are detected, the risk for infection with Mycobacterium tuberculosis may be among the highest recently documented [8,9,10]. Rates of MDR TB are high, with a national prevalence of 3% among patients never treated for TB and 12.3% among previously treated patients [11]. During 1990–2000, Peru implemented a model program based on the World Health Organization (WHO)–endorsed strategy of directly observed treatment, short course (DOTS) [12]. Massive use of sputum smear microscopy and standardized first-line treatment resulted in effective case detection and cure, with an overall decrease in TB incidence by the end of the decade [13]. Because DOTS alone was insufficient to control ongoing transmission of drug-resistant strains [15], Partners in Health (PIH), Harvard University, Massachusetts State
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