Interventions Reduce Laboratory Turnaround Time for Faster Diagnosis of Tuberculosis
September 21st, 2021 | Viewpoint
September 21st, 2021 | Viewpoint
The National Tuberculosis Program (NTP) helps curb the spread of tuberculosis (TB) infection in Kyrgyzstan. Because of the high burden of drug-resistant TB (DR-TB) in the country, rapid detection of new cases is essential to put patients on effective treatment regimens as soon as possible. When left untreated, one TB patient can infect up to 15 people in their close environment. However, when started on effective treatment, a TB patient is no longer infectious after just two weeks.
Drug-resistant TB is particularly difficult to diagnose. It requires advanced tests that are conducted in specialized laboratories, often located in the capital city and regional centers. Drug susceptibility testing (DST), which detects how well a particular strain of TB will respond to the different TB drugs available to treat it, uses state-of-the-art molecular genetic tests to determine a strain’s resistance profile. This information is critical to prescribing an appropriate treatment regimen with an effective combination of drugs. Without this information, delays in starting treatment—or prescribing the wrong treatment—can lead to the continued spread of infection, worse treatment outcomes for patients, and increased resistance to TB drugs.
In 2017, TB patients could wait up to three months to receive their DST results, and were often prescribed the wrong course of treatment in the meantime. Now, thanks to a USAID-funded initiative, the turnaround time (TAT) has decreased significantly and patients can receive their results in as little as 5 days.
The USAID Cure Tuberculosis Project has implemented a fully electronic information system to capture and share laboratory data between the laboratories performing TB diagnostic tests and DST and the health centers prescribing TB treatment. Information is automatically uploaded in the system and linked to individual TB patient records, reducing errors in patient data and tests results. This Laboratory Data Management Information System (LDMIS) provides clinicians with test results in real time, allowing for quick decision-making on the course and initiation of TB treatment. Laboratory technicians and clinicians who work with LDMIS confirm that the system has streamlined their work processes and workload.
Nurzhamal Mamytova, the Director of the Naryn Oblast TB Center (NOTC), shares the advantages of the LDMIS from the point of view of a TB doctor who needs test results to make evidenced-based treatment decisions: “With the introduction of electronic information technologies, the quality of work has significantly improved: we receive tests on time, especially DST,” says Dr. Mamytova. “We no longer wait for paper-based [test results], but start treating a patient with the receipt of electronic results. LDMIS and the clinical module [e-TB Register] improved timely diagnosis and the ability to monitor treatment.”
In addition to the LDMIS, the Cure Tuberculosis Project helped develop other clinical information systems that record patient data, improved and simplified clinical processes, and developed recording and reporting forms to calculate test turnaround time. Now, all of this information can be monitored automatically through LDMIS. The project also helped improve the sputum transportation system, which transports patients’ biological samples to centralized laboratories for testing. By mapping facilities and developing clearer transportation routes, the improved transportation system facilitates faster receipt and testing of samples by laboratories.
In laboratory work, it is important to produce an accurate and reliable result. In recent years, the timely receipt of test results improved. LDMIS and the transportation system improved the delivery of pathological material to the NRL and the time for laboratory tests. For a patient, it’s a plus as timely results allow prompt and effective treatment,” says Azima Jumalieva, head of the NOTC laboratory.
For patients, quicker test results mean a faster diagnosis, an earlier start of treatment, and a better chance of success in being cured. This also means being able to return to a normal social life without the risk of infecting families, friends, and co-workers.
USAID has been assisting the NTP with the development and nationwide implementation of advanced technology, systems, and processes that enable earlier TB detection, diagnosis, and treatment initiation. These new technologies and procedures, combined with modern treatment algorithms, help to improve both the patients’ experience and the capacity of health care professionals when prescribing, managing, and monitoring treatment.
The LDMIS has been implemented in 100% of oblast TB laboratories and TB hospitals, and in primary health care facilities providing TB services to the population nationwide. The LDMIS has reduced the TAT for molecular genetic tests three-fold for both Xpert testing and phenotypic DST (through culture), and six-fold for HAIN. The switch from paper-based referrals to LDMIS, together with other USAID interventions (strengthened transportation system with a reduced delivery time of patient sputum samples in three pilot regions of Chui, Talas, and Naryn, and the new quality management system implemented in laboratories), has reduced data and treatment errors while enabling faster diagnosis and earlier start of treatment for TB patients, thus helping to curb the spread of infection and improve the quality of TB treatment.