Lessons from the Field

Diagnostic system strengthening for drug resistant tuberculosis in Nigeria: impact and challenges

Gambo Aliyu, Nicholas Ezati, Mosunmola Iwakun, Sam Peters, Alash’le Abimiku
African Journal of Laboratory Medicine | Vol 6, No 2 | a502 | DOI: https://doi.org/10.4102/ajlm.v6i2.502 | © 2017 Gambo Aliyu, Nicholas Ezati, Mosunmola Iwakun, Sam Peters, Alash’le Abimiku | This work is licensed under CC Attribution 4.0
Submitted: 10 June 2016 | Published: 31 March 2017

About the author(s)

Gambo Aliyu, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States
Nicholas Ezati, Institute of Human Virology, Abuja, FCT, Nigeria
Mosunmola Iwakun, Institute of Human Virology, Abuja, FCT, Nigeria
Sam Peters, Institute of Human Virology, Abuja, FCT, Nigeria
Alash’le Abimiku, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States


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Abstract

Background: The increasing prevalence of drug-resistant tuberculosis and the threat of extensively-drug-resistant tuberculosis in HIV hotspots have made the detection and treatment of drug-resistant tuberculosis in the sub-Saharan Africa setting a global public health priority.

Objective: We sought to examine the impact and challenges of tuberculosis diagnostic capacity development for the detection of drug-resistant tuberculosis and bio-surveillance using a modular biosafety level 3 (BSL-3) laboratory in Nigeria.

Method: In 2010, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) programme, through the Institute of Human Virology at the University of Maryland in Baltimore, Maryland, United States, deployed a modular, BSL-3 laboratory to support the national tuberculosis programme in drug-resistant tuberculosis detection and bio-surveillance for effective tuberculosis prevention and control.

Results: From 2010 until present, sputum samples from 11 606 suspected cases in 33 states were screened for drug-resistant tuberculosis. Of those, 1500 (12.9%) had mono-resistant tuberculosis strains, and 459 (4.0%) cases had multidrug-resistant tuberculosis. Over the lastfour years, 133 scientists were trained in a train-the-trainer programme on advanced tuberculosis culture, drug susceptibility testing, line-probe assays and Xpert® MTB/RIF, in addition to safety operations for biosafety facilities. Power instability, running cost and seasonal dust are notable challenges to optimal performance and scale up.

Conclusion: Movable BSL-3 containment laboratories can be deployed to improve diagnostic capacity for drug-resistant tuberculosis and bio-surveillance in settings with limited resources.


Keywords

Drug-resistant tuberculosis; BSL 3 laboratory; Nigeria

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