title: Field and laboratory preparedness: challenges to rolling out new multidrug-resistant tuberculosis diagnostics.
abstract: OBJECTIVE
  In a pilot implementation project of the microscopic-observation drug-susceptibility methodology, we conducted a process evaluation to identify health system and logistic challenges that need to be addressed in order to harness the benefits of rolling out promising new diagnostic tools for multidrug-resistant tuberculosis (MDRTB).
  
  
  METHODS
  Regional data relating to health system practices and performance related to the MDRTB diagnostic algorithm were collected at health center, local, and regional laboratories.
  
  
  RESULTS
  Parallel implementation of a new test and an existing method creates demands on funds, personnel, sample transport, and information systems in addition to new test startup costs. Obviating the need for primary culture at intermediate laboratories through direct drug susceptibility testing (DST) at the regional reference laboratory significantly reduces delay. Field application of well-defined national guidelines for DST is patchy. If fidelity to national guidelines were perfect, DST requests would increase more than 50-fold, with important implications for laboratory capacity.
  
  
  CONCLUSIONS
  Implementing a new MDRTB diagnostic presents challenges to the laboratory environment, the existing DST process, and the application of national guidelines in peripheral clinics. Assessing each element can maximize efficient use of a new tool. Specifically, strengthening systems for transferring samples to the laboratory and delivering results to the requesting clinic in addition to investing in personnel and laboratory resources are integral to harnessing the benefits of high-performance new diagnostic tests and can bring added value to other programs in the health care system.
authors.affiliation: Massachusetts General Hospital, Boston, 02114, United States of America. amjgriffin@gmail.com
authors.forename: Anne M J
authors.initials: AM
authors.lastname: Griffin
authors.forename: Luz
authors.initials: L
authors.lastname: Caviedes
authors.forename: Robert
authors.initials: R
authors.lastname: Gilman
authors.forename: Jorge
authors.initials: J
authors.lastname: Coronel
authors.forename: Freddy
authors.initials: F
authors.lastname: Delgado
authors.forename: MaryLuz
authors.initials: M
authors.lastname: Quispe
authors.forename: David A J
authors.initials: DA
authors.lastname: Moore
mesh_terms: D007753:Laboratories / Q000458:organization & administration* / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000382:microbiology*