Sophisticated laboratory support is essential to any treatment program for multidrug-resistant tuberculosis (MDR-TB). In many resource-poor settings existing laboratory capacity is inadequate to ensure accurate diagnosis and drug-susceptibility testing for cases of suspected MDR-TB. Molecular fingerprinting (RFLP), which is rarely available in resource-poor country facilities, is also critical for understanding the epidemiology and magnitude of an MDR-TB outbreak.
This paper describes a transnational collaboration among the Massachusetts State Laboratory Institute (MSLI), non-governmental organizations in Peru (Socios en Salud) and Massachusetts (Partners In Health), the Peruvian National Tuberculosis Control Program (PNCT), and Harvard Medical School, through which clinicians and laboratory personnel work to diagnose and treat MDR-TB in an urban shantytown of Lima. Cultures of M. tuberculosis collected from patients in this community are sent to the MSLI for quality control and drug-susceptibility testing (DST). DST results transmitted to Socios by e-mail and fax are used to guide clinical decision-making regarding the composition of (and adjustment to) individualized treatment regimens. Molecular fingerprinting results aid the team in developing interventions to interrupt transmission.
Benefits of this approach include the sustainability and reduced cost of the project: rather than establishing a new lab in this resource-poor setting, the PNCT is supported by existing, underutilized, yet sophisticated lab services in the US. Moreover, Peruvian lab and clinical staff receive frequent training in the US through this collaboration. Lastly, for staff at the MSLI, access to these cultures from Peru provides a unique opportunity for rapid improvement of proficiency in DST and RFLP.
Learning Objectives: Participants in this session will be able to enumerate the components of a successful, collaborative, sustainable DOTS-Plus program for the treatment of MDR-TB. Participants will also be able to identify settings in which such a model might be replicated
Keywords: TB, Collaboration
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.