1. Strengthening National Lab. Network for diagnosis of TB and HIV: Challenges and solutions. Nicholas Wambua MD; MPH; DTCE. Technical Advisor -Tuberculosis CDC –Nairobi WHO/OGAC TB/HIV MEETING KIGALI

2. Presentation Outline Overview of TB situation TB laboratory services Challenges in provision of TB lab services Possible Solutions

5. HIV testing in TB sites Decision on where HIV testing is done depends on: – TB caseload –available manpower –infrastructure NLTP recommends: TB Clinic Next door room Lab VCT site Testing by frontline TB clinicians / nurses/Lab Technicians Targeting: TB patient Ultimately - TB suspect

6. Results of HIV testing: 2006 Proportion tested = 60% HIV prevalence = 52% On CTX = 80% On ARVs = 22%

7. Current Laboratory situation

8. Funding for TB laboratory services MOH (NPHLS & NLTP): Current partners: PEPFAR USAID GFATM MSF WHO/OGAC Planned Partners: CIDA/KNCV (2007)

9. Challenges: Availability and accessibility Inadequate No. of labs Mal-distribution of laboratories Inadequate space Lack of interaction with private sector labs Insufficient financial resources

10. Challenges: Human resources Inadequate human resources at all levels No career structures and opportunities Motivation training

11. Challenges: Quality Management Systems Inadequate support supervision Weak communication between NTP and Lab Limited implementation of QA system Poor maintenance of microscopes

12. Challenges: Weak Central Reference laboratory Poor coordination (NLTP/NPHL/KEMRI) –Communication –Leadership –Funding Physical infrastructure Specimen logistics-transport and tracking Difficulties in implementing EQA

13. Solutions: Availability and accessibility Assess service coverage –Consider pop. distribution, transport, and TB prevalence Involve private laboratory networks –Encourage use of national SOPs and training modules, supervision and EQA Include funds for lab expansion in lab budgets

14. Solutions: Human Resources Ensure sufficient staffing Maximize use of existing HR Provide career opportunities /progression Improve salaries and work conditions Training –Ensure current proficiency standards –Training on new techniques

15. Solutions: Quality Management Systems Implement a well functioning QA system Strengthen supervision and management at all levels Develop a functional and sustainable maintenance system of microscopes

16. Solutions: Weak Central Reference laboratory Regular meetings between NTP, CRL Better planning with involvement of NTP Include funds for lab expansion in lab budgets

17. Priorities for FY 08 Human Resources: Staff training Infrastructure: Renovations Purchase of machines/equipment MDR TB Specimen delivery, tracking and reporting systems Culture and DST

18. Priorities for FY 08 Quality Management Systems Coordination among partners and MOH National EQA program Support supervision M&E

19. Thank you