title: Scale-up of multidrug-resistant tuberculosis laboratory services, Peru.
abstract: Over the past 10 years, the Peruvian National Tuberculosis (TB) Program, the National Reference Laboratory (NRL), Socios en Salud, and US partners have worked to strengthen the national TB laboratory network to support treatment of multidrug-resistant TB. We review key lessons of this experience. The preparation phase involved establishing criteria for drug susceptibility testing (DST), selecting appropriate DST methods, projecting the quantity of DST and culture to ensure adequate supplies, creating biosafe laboratory facilities for DST, training laboratory personnel on methods, and validating DST methods at the NRL. Implementation involved training providers on DST indications, validating conventional and rapid first-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting. Monitoring included ongoing quality control and quality assurance procedures. Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation. Operational research guided laboratory scale-up and identified barriers to effective capacity building.
authors.affiliation: Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA. sshin@partners.org
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Shin
authors.forename: Martin
authors.initials: M
authors.lastname: Yagui
authors.forename: Luis
authors.initials: L
authors.lastname: Ascencios
authors.forename: Gloria
authors.initials: G
authors.lastname: Yale
authors.forename: Carmen
authors.initials: C
authors.lastname: Suarez
authors.forename: Neyda
authors.initials: N
authors.lastname: Quispe
authors.forename: Cesar
authors.initials: C
authors.lastname: Bonilla
authors.forename: Joaquin
authors.initials: J
authors.lastname: Blaya
authors.forename: Allison
authors.initials: A
authors.lastname: Taylor
authors.forename: Carmen
authors.initials: C
authors.lastname: Contreras
authors.forename: Peter
authors.initials: P
authors.lastname: Cegielski
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use; D003470:Culture Media; D006801:Humans; D007753:Laboratories / Q000458:organization & administration / Q000592:standards / Q000600:supply & distribution; D008826:Microbial Sensitivity Tests / Q000379:methods / Q000706:statistics & numerical data; D008828:Microbiological Techniques / Q000379:methods; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D010568:Peru; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D003470:Culture Media