The New Profile of Drug-Resistant Tuberculosis in Russia A Global and Local Perspective: Summary of a Joint Workshop by the Institute of Medicine and the Russian Academy of Medical Science (2011) / Chapter Skim
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5 Diagnosis of Drug-Resistant TB
5 Diagnosis of Drug-Resistant TB
Pages 49-62
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From page 49... ...
Presentations on the diagnosis of drug-resistant TB addressed rapid diagnostic methods, the use of biochip technology, and the need for improved laboratory capacity.
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From page 50... ...
These products can determine which strains are resistant or sensitive to specific drugs through colorimetric methods, with automatic detection and no use of test tubes, and reduce the time required to obtain drug susceptibility results to 6−13 days. The molecular-genetic methods rely on detection of mutations in the DNA of M.tb.
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From page 51... ...
SOURCE: IOM, 2011. aThe information provided in this box was originally presented by Paul van Helden, Stellen bosch University, and summarized in the IOM Drug Forum's second workshop on the subject of drug-resistant TB held in 2010 in Pretoria, South Africa (IOM, 2011)
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From page 52... ...
Kathleen Eisenach, University of Arkansas, pointed out that the Institute of Tropical Medicine in Antwerp does quality control testing for drug susceptibility tests worldwide. A panel of isolates, including MDR TB strains, is circulated to laboratories once or twice a year, which provides an opportunity for proficiency testing.
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From page 53... ...
In the discussion period, Carlos Pérez-Vélez of the National Jewish Hospital, Denver, Colorado, commented on the treatment of mycobac teriosis at the hospital, which typically has 10 such patients who have been referred from around the world. An interdisciplinary team of pul monologists and infectious disease specialists manages these patients, who usually require prolonged courses of multiple antibiotics.
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From page 54... ...
Today, biochips are based on three-dimensional gel pads on a plastic surface rather than two-dimensional glass surfaces, which increases the sensitivity of analysis and leads to excellent discrimination levels. Point mutations are detected by DNA hybridization on the biochip, with fluorescence intensities being compared to determine whether tested DNA bears a particular mutation.
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From page 55... ...
According to the GLI, "The global lack of TB laboratory capacity constitutes a global crisis, requiring a paradigm shift in providing laboratory policy guidance, quality assurance and knowledge creation within a global and integrated laboratory network." Some of the challenges and successes of improving laboratory diagnostic capacity are illustrated in Box 5-3. Several critical issues surround global laboratory capacity, Nordenberg said: • L aboratory capacity is desperately insufficient.
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From page 56... ...
• T here is a critical need as well for "operations" systems to track such activities as infection control programs and therapeutic supply chains. BOX 5-3 Diagnostics and Laboratory Infrastructure in South Africaa Dr.
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From page 57... ...
Also needed are drugs that will shorten treatment, be effective against both susceptible and resistant strains, be compatible with antiretroviral therapies, and improve the treatment of latent infection; a vaccine that is safe and effective for children, adolescents, and adults, the culture will undergo a line probe. This is an expensive process, but less so than first-line drug susceptibility testing.
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From page 58... ...
Such a system is a tool that supports the work of laboratories as opposed to that of clinicians or health epidemiologists. A laboratory information management system needs to perform a diverse set of functions -- test requisition, test receipt documentation, sample management, testing and validation, report distribution, report receipt documentation, test scheduling, sample collection, chain of custody, reagent management, quality assurance, and others.
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From page 59... ...
It is intentionally designed to be dynamic so that it can be optimized through continuous performance improvement. And it provides the ability to integrate data across laboratories, clinical programs, and public health programs.
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From page 60... ...
But usually you are going to be disappointed." To realize the full benefits of information systems, the laboratory, clinic, and public health entities in a given area need to work together. Nordenberg illustrated this point: "If you can get a laboratory result in 2 days or in 3 weeks, but then it takes another week to get the result of that test to somebody, that's going to have serious costs in terms of delayed diagnosis and increased spread." Especially with TB, the cost of a broken information supply chain can be calculated in both human and financial terms.
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From page 61... ...
A workshop participant asked how data from private practitioners in many countries can be integrated in the same system, since the same platform probably will not be used to communicate results. Nordenberg observed that the same situation exists in the United States, where a wide diversity of independently run systems exists in both the public and private sectors.
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From page 62... ...
A workshop participant asked whether the widely varying results of drug susceptibility testing in China argue for the use of individualized rather than standardized treatments for MDR TB. Nordenberg asked whether the laboratory results are fed into the patient information system.
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