Improving the Quality and Performance of TB Culture Laboratory Services Through Cold Chain Specimen Transportation System in Ethiopia
At the beginning of the HEAL TB project in 2011, culture and drug susceptibility testing (DST) using solid media was available to the program in two regions to detect drug-resistant tuberculosis (DR-TB) and for monitoring treatment response, which made identifying drug- resistance patterns possible and allowed health care workers to provide more appropriate drug treatment for DR-TB patients. However, the limited number of culture laboratories, weak and uncoordinated specimen referral linkages, long distances between referring and testing sites, and weak means of transportation led to delays in specimen collection and delivery to testing sites and delays in delivering results, which hindered patient care and follow up activities in two regions. The introduction of new diagnostic technologies, particularly GeneXpert MTB/RIF service, was also challenging because of weak referral linkages, resulting in the inaccessibility of the service to support implementing programmatic management of drug-resistant tuberculosis (PMDT).
Thus, the HEAL TB project, Regional Health Bureau (RHB)/RL and EPHI identified TB specimen referral as a critical weakness that not only threatened the efficiency and accuracy of the laboratory service, but also influenced timely patient access to appropriate diagnostic services in routine programmatic practice. Thus, strengthening the TB specimen referral system in two regions was selected as a priority activity for collaboration between RHB/RL and the National Tuberculosis Program (NTP)/EPHI.