Tuberculosis laboratory network and quality assurance of sputum smear microscopy in laboratories in Papua New Guinea

Abstract

<h3>Introduction</h3> Tuberculosis (TB) is a very serious health problem in Papua New Guinea (PNG). According to the World Health Organization (WHO), PNG is one of the seven high burden countries in the Western Pacific region. The new smear positive case detection rate is 20% of the estimated burden in 2004 and has yet to improve. The target is to achieve a new smear positive case detection rate of at least 70% of the estimated cases and to cure at least 85% of cases. Consequently, without a strengthened laboratory network and an effective external quality assurance system, the case detection rate and cure rate cannot be achieved. <h3>Aim</h3> To at least increase the current new smear positive detection and cure rate by ensuring quality assured microscopy results and competent laboratory personnel in a well organised laboratory network. <h3>Method</h3> Existing laboratory facilities with and without laboratory personnel were identified accordingly. Training was provided for the laboratory personnel identified, and reagents, laboratory consumables and microscopes were supplied for acid-fast bacilli (AFB) microscopy to be done at these health facilities. Laboratory technicians for the national, regional and provincial laboratories were recruited to boost the manpower for the increased workload. The components of quality assurance that were applied were blinded re-checking using the Lot Quality Assurance System (LQAS) method, panel testing and supervisory visits. <h3>Results</h3> The number of trained laboratory personnel and quality assured microscopy centres has increased, hence increasing the diagnosis of cases. Microscopy facilities taking part in External Quality Assurance (EQA) has also increased resulting in increased workload. EQA is seen to strengthen the laboratory network and has improved diagnostic quality. <h3>Discussion</h3> Sputum smear microscopy is still the gold standard for diagnosis of tuberculosis in PNG;however it depends on the dedication of the laboratory personnel and an effective EQA system. Training programs have to be well organised, must suit the level of laboratory personnel trained and must involve key people at all levels of the network. Tuberculosis laboratory services in PNG are integrated with general laboratory services and therefore require input from management at each level of the network in regard to manpower and roles of key personnel involved in the tuberculosis program. <h3>Conclusions</h3> A good quality tuberculosis control program depends on well trained staff, a strengthened laboratory network and an effective EQA system.