title: Assessing the effect of decentralisation of laboratory diagnosis for drug-resistant tuberculosis in Kenya.
abstract: METHODS
  Drug susceptibility testing (DST) is recommended in Kenya to identify multidrug-resistant tuberculosis (MDR-TB) in persons registered for tuberculosis (TB) retreatment. DST is performed at a central laboratory with a two-step growth-based process and a regional laboratory with a simultaneous molecular- and growth-based process.
  
  
  OBJECTIVE
  To compare proportions of retreatment cases who underwent DST and turnaround times for hospitals referring to the central vs. regional laboratory.
  
  
  METHODS
  Cases were persons registered for TB retreatment from 1 January 2012 to 31 December 2013. Records of 11 hospitals and 7 hospitals referring patients to the regional and central laboratories, respectively, were reviewed.
  
  
  RESULTS
  Respectively 238/432 (55%) and 88/355 (25%) cases from hospitals referring to the regional and central laboratories underwent DST. The mean time from case registration to receipt of DST results and initiation of MDR-TB treatment was quicker in hospitals referring to the regional laboratory. The time required for the transportation of specimens, specimen testing and receipt of DST results at hospitals was shorter for the regional laboratory (P < 0.05).
  
  
  CONCLUSIONS
  Testing was faster and more complete at hospitals referring to the regional laboratory. A comprehensive review of MDR-TB detection in Kenya is required to increase the proportion of cases receiving DST.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Kenya Medical Research Institute, Kisian, Kenya.
authors.forename: S
authors.initials: S
authors.lastname: Musau
authors.affiliation: Division of Tuberculosis Elimination, CDC, Atlanta, Georgia, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Heilig
authors.affiliation: Kenya Medical Research Institute, Kisian, Kenya.
authors.forename: A O
authors.initials: AO
authors.lastname: Okumu
authors.affiliation: Kenya Medical Research Institute, Kisian, Kenya.
authors.forename: E O
authors.initials: EO
authors.lastname: Opiyo
authors.affiliation: Division of Global HIV/AIDS, CDC, Kisumu, Kenya.
authors.forename: F L
authors.initials: FL
authors.lastname: Basiye
authors.affiliation: Division of Global HIV/AIDS, CDC, Kisumu, Kenya.
authors.forename: F O
authors.initials: FO
authors.lastname: Miruka
authors.affiliation: Division of Tuberculosis and Lung Disease, Ministry of Health, Kenya.
authors.forename: J K
authors.initials: JK
authors.lastname: Kioko
authors.affiliation: Division of Communicable Disease Prevention and Control, Ministry of Health, Kenya.
authors.forename: J K
authors.initials: JK
authors.lastname: Sitienei
authors.affiliation: Division of Tuberculosis Elimination, CDC, Kisumu, Kenya.
authors.forename: K P
authors.initials: KP
authors.lastname: Cain
mesh_terms: D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007630:Kenya; D007753:Laboratories / Q000592:standards*; D008826:Microbial Sensitivity Tests; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019233:Retreatment; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy