title: 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.
authors.affiliation: College of Health Sciences, Makerere University National Tuberculosis Reference Laboratory.
authors.forename: Moses
authors.initials: M
authors.lastname: Joloba
authors.affiliation: Centers for Disease Control and Prevention (CDC)-Uganda.
authors.forename: Christina
authors.initials: C
authors.lastname: Mwangi
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Heather
authors.initials: H
authors.lastname: Alexander
authors.affiliation: National Tuberculosis Reference Laboratory.
authors.forename: Diana
authors.initials: D
authors.lastname: Nadunga
authors.affiliation: College of Health Sciences, Makerere University.
authors.forename: Freddie
authors.initials: F
authors.lastname: Bwanga
authors.affiliation: National Tuberculosis Reference Laboratory.
authors.forename: Nelson
authors.initials: N
authors.lastname: Modi
authors.affiliation: Centers for Disease Control and Prevention (CDC)-Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Downing
authors.affiliation: Centers for Disease Control and Prevention (CDC)-Uganda.
authors.forename: Agnes
authors.initials: A
authors.lastname: Nabasirye
authors.affiliation: National Tuberculosis and Leprosy Programme, Kampala, Uganda.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Adatu
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Ritu
authors.initials: R
authors.lastname: Shrivastava
authors.affiliation: Becton, Dickinson, and Company, Franklin Lakes, New Jersey.
authors.forename: Renuka
authors.initials: R
authors.lastname: Gadde
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: John N
authors.initials: JN
authors.lastname: Nkengasong
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D006268:Health Facilities; D006282:Health Personnel / Q000193:education; D006301:Health Services Needs and Demand; D006801:Humans; D007753:Laboratories / Q000458:organization & administration* / Q000592:standards; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009313:National Health Programs; D055818:Public-Private Sector Partnerships; D012017:Referral and Consultation; D013048:Specimen Handling; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000382:microbiology; D014454:Uganda
keywords: Mycobacterium tuberculosis; Uganda; drug suscpectibility testing; multidrug-resistant tuberculosis; public-private partnership; specimen referral