The Unsung Heroes of Tuberculosis Control

MSH works with the Global Drug Facility to help laboratory staff in Congo-Brazzaville improve tuberculosis detection

Tuberculosis (TB) is a public health emergency: 8 million people worldwide develop active TB each year. Diagnosing patients with TB, by examining their sputum under the microscope to detect tuberculosis bacteria, is pivotal to the control of this disease. This relatively simple, but labor-intensive laboratory test requires great concentration and attention to detail. It can be tedious even in the best-equipped laboratories, but is much more difficult for staff in resource-poor countries, where basic equipment and materials are often lacking. This is the case in Congo-Brazzaville, a country in central Africa with high rates of TB, where the three-year civil war between 1997 and 1999 disrupted the activities of the national TB program and destroyed 80% of laboratory resources.

Despite the harsh conditions, laboratory staff in the two major cities, Brazzaville and Pointe-Noire, have been seeking creative ways to keep their laboratory services running. For example, when they ran out of sputum collection containers for patients to provide specimens, technicians enlisted the help of local photo shops to supply them with film canisters to serve that purpose. When the electricity needed to power the microscopes goes out during the daytime, they often return to the laboratory at night when the power comes back on, to read the slides and provide test results as quickly as possible. These motivated laboratory technicians, working behind the scenes to ensure that patients are diagnosed in a timely manner, are indeed among the "unsung heroes" of TB control.

The Global TB Drug Facility (GDF) and Management Sciences for Health (MSH) are experimenting with the development of diagnostic laboratory kits for use in resource-poor countries with high rates of TB. Over the last year, they have been working together to design standardized "test kits" containing all the essential items needed for sputum microscopy: good microscopes with rechargeable backup batteries, disposable sputum collection cups, and stains and reagents to prepare the smears, as well as other basic laboratory equipment. Congo-Brazzaville is the first country to receive these kits for evaluation. They are also being tested in Nigeria and Tajikistan.

Most cases of TB are curable by treatment with standardized drug regimens. Until recently one of the major barriers to TB control was the lack of appropriate low-cost TB drugs. Since 2001, the GDF and its partners have been providing these to many countries worldwide, including Congo-Brazzaville. With MSH's assistance, the GDF is now looking to expand its activities to address the challenge of providing high-quality diagnostic services. If successful in the trial tests, the new laboratory kits will also be made available worldwide. Appropriate laboratory supplies and equipment are critical resources for laboratories to provide the accurate diagnoses required to start patients on TB drug therapy and to monitor their progress during treatment.