Uganda ranks 16th of 22 global high-burden tuberculosis (TB) countries and in 2009 had approximately 42,178 new TB cases and 9,400 TB deaths. And Uganda is not alone – Tanzania, Kenya, Ethiopia and the Democratic Republic of Congo are all high TB burden countries in East Africa.
Multidrug Resistant TB, or ‘MDR’ TB, is increasing in East and Central Africa due to challenges in delivering quality treatment regimens that help TB patients take their medication strictly as prescribed. Not taking the full course of drugs or taking them inconsistently can cause the tuberculosis bacteria to mutate and become resistant to the drugs used to treat TB. Thus, the contagious and difficult to treat MDR-TB can develop in individuals and be transmitted to others. In 2008, there were approximately 69,000 cases of MDR-TB in Africa.
Uganda’s National TB Reference Laboratory in Kampala processes and tests patient specimens from across the country to provide quality testing and control to ensure that local labs are correctly diagnosing patients who test for TB. Local labs throughout Uganda rely on this Ministry of Health National TB Reference Lab to provide quality assurance for the diagnosis of TB and MDR-TB, and to provide training on new lab technologies.
Soon, with USAID’s support, Uganda’s National TB Reference Lab will assume this responsibility for the entire East Africa region. The lab was recently granted ‘candidate’ status to join the TB Supranational Reference Laboratory Network of the WHO Global Laboratory Initiative. This new status recognizes the lab as a provider of TB laboratory strengthening support to other national reference laboratories in countries throughout East Africa, and means that it can accept samples from any lab in Africa to provide quality assurance services.
This WHO designation also puts the lab on schedule to win official accreditation status, pending the next and final assessment to be carried out in 2012. This outstanding achievement would make the Supranational TB Reference Lab in Kampala only the second of its kind in Sub-Saharan Africa, representing four years of financial and technical support from USAID/East Africa.
Until now, poor laboratory and quality infrastructure for TB testing and diagnosis have been a major challenge. National TB labs in Sub-Saharan Africa had to send their sputum samples to South Africa or Europe for quality diagnostic testing. This has made quality control processes costly and difficult, and many samples have been sent to labs ill-equipped to carry out the necessary procedures.
Now, Uganda’s Supranational Reference Laboratory will be able to carry out accurate diagnostic testing to provide WHO-recommended quality control and support to labs throughout the region to diagnose patients accurately.
The lab is also strengthening the staff of national laboratories of countries in the region, such as the new Republic of South Sudan, through targeted practical trainings. Two laboratory experts from South Sudan, Dr. Habib Dada and Dr. Anthony Worri, traveled to Uganda to gain new skills and techniques to bring home to their national TB reference lab in Juba. The four week training provided advanced understanding of lab techniques involving sputum analysis, sterility checks, sample staining for fluorescence microscopy, and Drug Susceptibility Testing – important for testing samples for MDR-TB. The trainees left feeling confident they could share these practices in their home lab. They also plan to use Uganda’s Supranational Reference Lab to provide crucial quality control services in the future. “Now that we know they will become accredited, I think we will send samples here for quality control,” said Dr. Worri.