Strengthening the Tuberculosis Specimen Referral Network in Uganda: The Role of Public-Private Partnerships

Abstract

Background Diagnosis of multidrug-resistant tuberculosis and prompt initiation of effective treatment rely on access to rapid and reliable drug-susceptibility testing. Efficient specimen transport systems and appropriate training on specimen referral contribute to optimal and timely access to tuberculosis diagnostic services. Methods With support and technical assistance from a public-private partnership (PPP) between Becton Dickinson and the US President’s Emergency Plan for AIDS Relief, the Uganda National TB Reference Laboratory (NTRL) and National TB and Leprosy Program redesigned the tuberculosis specimen transport network and trained healthcare workers with the goal of improving multidrug-resistant tuberculosis detection. Results Between 2008 and 2011, the PPP mapped 93% of health facilities and trained 724 healthcare and postal staff members covering 72% of districts. Strengthening the tuberculosis specimen referral system increased referrals from presumptive multidrug-resistant tuberculosis cases by >10-fold, with 94% of specimens reaching the NTRL within the established target transport time. Conclusions This study demonstrates the potential of PPP collaborations with ministries of health to positively influence patient care by strengthening laboratory systems through increased access to drug-susceptibility testing in Uganda. Ongoing efforts to integrate specimen transport networks will maximize resources and improve patient management.

Multidrug-resistant tuberculosis surveillance and cascade of care in Madagascar: a five-year (2012–2017) retrospective study

“…The benefits of strengthening referral systems on delays and diagnosis rates have been demonstrated in other low-income countries [35]. In Madagascar, innovative technologies such as drones were recently tested to accelerate access to diagnosis and render TB care more patient-centric by overcoming pertinent logistic barriers on the last mile [36].…”

Designing and Piloting a Specimen Transport System in Burkina Faso

“…Our findings of increased proportion of specimens transported and reduced transportation time using the postal system were similar to previous studies. 15,16 Colleagues in Guinea also worked to establish a specimen referral and transport system following the West Africa Ebola virus disease outbreak, and they have documented the importance of collaborating closely with the ministry of health and conducting a baseline assessment to inform system design. 17 The specimen transport system pilot had some significant limitations.…”

Integrating tuberculosis and antimicrobial resistance control programmes

“…For example, establishment of an efficient and far-reaching specimen referral network has been explored by investigators in Ethiopia and Uganda, and shown to be effective for multiple diseases, including tuberculosis, HIV and hepatitis. 21 , 24 Therefore, establishing shared laboratory spaces, equipment and supplies, human resources and transport systems would be mutually beneficial to both tuberculosis and antimicrobial resistance programmes and improve universal access to diagnostics for the population served.…”