Diagnosis of TB in Belarus, statistics and challenges of establishing an accurate and timely DR-TB diagnosis in high MDR-TB prevalence settings

Transcription

1 Tuberculosis in 2017: Searching for new solutions in the face of new challenges 6th TB Symposium Ministry of Health of the Republic of Belarus, Republican Scientific and Practical Center for Pulmonology and Tuberculosis, and Médecins Sans Frontières 1-2 March, 2017, MINSK, BELARUS Diagnosis of TB in Belarus, statistics and challenges of establishing an accurate and timely DR-TB diagnosis in high MDR-TB prevalence settings Elena Nikolenko, National TB laboratory

2 Elena Nikolenko, National TB laboratory (NRL) March 01-02, 2017, Minsk

3 SNRL NRL Laboratories Labaratory Network: 3 BSL laboratories (7) 2 BSL laboratories (19) 1 BSL laboratories (128) TB - Laboratory Network RRL BELARUS

4 Laboratory network (new methods are included) NRL (GX-2) 3 BSL laboratories (GX-8) 2 BSL laboratories (GX-13) 1 BSL laboratories (GX-7) Grodno Minsk Vitebsk Mogilev Gomel Brest RRL BELARUS

5 Doctors Laboratory technicians

6 XpertMTB/Rif 1 st sputum sample Microscopy Culture / drug susceptibility testing on solid and soft media 2nd sputum sample Microscopy Culture / drug susceptibility testing on solid and soft media LPA Microbiological diagnostics of TB

7 AFB+, GX+ RIF - S RIF - R LPA MTBDRplus DST for 1 st line drugs LPA MTBDRsl DST for 1 st and 2 nd line drugs Microbiological diagnostics of TB

8

9 SGM, Isolation Rate (%),

10

11

12 Xpert MTB/RIF Brest Vitebsk Gomel Grodno Minsk Oblast Mogilev Minsk Correctional facility No. 12 NRL

13 Brest Vitebsk Gomel Grodno Minsk Mogilev Correctional facility No. 12 NRL

14

15 This method is called "sputum smear microscopy Sputum culture Sputum culture Final outcome: Final outcome:

16 Microscopy Z-N Culture Löwenstein Jensen Culture MGIT 17 GX GX RIF-R negative result, % positive result, % LPA MTBDRplus RIF-R 36.3 LPA MTBDRsl Ag-R LPA MTBDRsl FQ-R

17 Efficiency of microscopic test carried to analyze the deposit in compliance with Ziehl-Neelsen method, Republic of Belarus (2016) 100% 98% 96% % 92% 90% AFB+ AFB diagnostics treatment 88% 5.0 monitoring 0.0

18

19 DST for diagnostics, 2016 H,R,E,Z Am,Km,Cm, Lfx,Mfx, Lzd 2045 H,R,E, Am,Km,Cm, 2800

20 Insufficient use of molecular tests (LPA & GX) and prolonged waiting for the LPA results Dependence on external supplies and irregularities in supplies Insufficient number of staff members Need to undertake reorganization in some 3 BSL laboratories

21 Increased efficiency and quality of tests, improved quality control of laboratory tuberculosis diagnostics During several last years the country s laboratories have been enrolled in external quality control of DST with excellent results Development of international co-operation

22 OBJECTIVR:50%: New cases OBJECTIVE: 70% Relapses: Objectives: 100% BACTERIOLOGICAL CONFIRMATION OF RESPIRATORY TUBERCULOSIS AMONG PRIMARY TB CASES (MOH, REPUBLIC OF BELARUS) BACTERIOLOGICAL CONFIRMATION OF RESPIRATORY TUBERCULOSIS (MOH, REPUBLIC OF BELARUS)

23 Confirmed TB cases among children in 2016, % Confirmed TB of other organs, 2016 (%) AFB+ Mycobacterium tuberculosis+ 0 Mycobacterium tuberculosis+

24 FIND Expand TB (technical assistance to the NRL and the laboratory of Minsk Oblast TB Dispensary) Expert ULTRA TB-SLMTA National Institutes of Health / National Institute of Allergy and Infection Diseases (NIH/NIAID): complete genomic sequencing

25 1) Genomic analysis of globally diverse Mycobacterium tuberculosis strains provides insights into the emergence and spread of multidrug resistance Abigail L Manson, Keira A Cohen, Thomas Abeel, Christopher A Desjardins, Derek T Armstrong, Clifton E Barry III, Jeannette Brand, TBResist Global Genome Consortium, Sinéad B Chapman, Sang-Nae Cho, Andrei Gabrielian, James Gomez, Andreea M Jodals, Moses Joloba, Pontus Jureen, Jong Seok Lee, Lesibana Malinga, Mamoudou Maiga, Dale Nordenberg, Ecaterina Noroc, Elena Romancenco, Alex Salazar, Willy Ssengooba, A A Velayati, Kathryn Winglee, Aena Skrahina, Sven Hoffner et al. Nature Genetics (2017) doi: /ng.3767, Received 30 June 2016 Accepted 14 December 2016 Published online 16 January ) Whole genome sequencing of Mycobacterium tuberculosis provides insight into the evolution and genetic composition of drug-resistant tuberculosis in Belarus. Wollenberg KR, Desjardins CA, Zalutskaya A, Slodovnikova V, Oler AJ, Quiñones M, Abeel T, Chapman SB, Tartakovsky M, Gabrielian A, Hoffner S, Skrahin A, Birren BW, Rosenthal A, Skrahina A, Earl AM. J Clin Microbiol Nov 30. 3) Multidrug-resistant Myobacterium tuberculosis caused by the Beijing genotype and a specific T1 genotype clone (SIT No. 266) is widely transmitted in Minsk Aksana Zalutskaya, Maria Wijkander, Pontus Jureen, Alena Skrahina, Sven Hoffner Int J of Mycobacteriology 2013; 2:

26

27

28 Introduction of a new diagnostics algorithm Capacity to apply rapid methods and molecular tests (GX and LPA) while diagnosing patients Centralization of the Laboratory Network Conduction of external quality assessment Preparation of the NRL for accreditation Increasing capacities of the NRL to ensure regular conduction of clinical and scientific trials

29 Acknowledgements