title: A novel sputum transport solution eliminates cold chain and supports routine tuberculosis testing in Nepal.
abstract: This preliminary study evaluated the transport reagent OMNIgene SPUTUM (OMS) in a real-world, resource-limited setting: a zonal hospital and national tuberculosis (TB) reference laboratory, Nepal. The objectives were to: (1) assess the performance of OMS for transporting sputum from peripheral sites without cold chain stabilization; and (2) compare with Nepal's standard of care (SOC) for Mycobacterium tuberculosis smear and culture diagnostics. Sixty sputa were manually split into a SOC sample (airline-couriered to the laboratory, conventional processing) and an OMS sample (OMS added at collection, no cold chain transport or processing). Smear microscopy and solid culture were performed. Transport was 0-8days. Forty-one samples (68%) were smear-positive using both methods. Of the OMS cultures, 37 (62%) were positive, 22 (36%) were negative, and one (2%) was contaminated. Corresponding SOC results were 32 (53%), 21 (35%), and seven (12%). OMS "rescued" six (i.e., missed using SOC) compared with one rescue using SOC. Of smear-positives, six SOC samples produced contaminated cultures whereas only one OMS sample was contaminated. OMS reduced culture contamination from 12% to 2%, and improved TB detection by 9%. The results suggest that OMS could perform well as a no cold chain, long-term transport solution for smear and culture testing. The findings provide a basis for larger feasibility studies.
authors.affiliation: German Nepal TB Project, Nepal Anti-Tuberculosis Association/GENETUP, Kalimati, Kathmandu, Nepal.
authors.forename: Bhagwan
authors.initials: B
authors.lastname: Maharjan
authors.affiliation: German Nepal TB Project, Nepal Anti-Tuberculosis Association/GENETUP, Kalimati, Kathmandu, Nepal.
authors.forename: Bhabana
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: DNA Genotek, 3000 - 500 Palladium Drive, Ottawa, ON K2V 1C2, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Weirich
authors.affiliation: DNA Genotek, 3000 - 500 Palladium Drive, Ottawa, ON K2V 1C2, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stewart
authors.affiliation: DNA Genotek, 3000 - 500 Palladium Drive, Ottawa, ON K2V 1C2, Canada. Electronic address: cassandra.kelly-cirino@dnagenotek.com.
authors.forename: Cassandra D
authors.initials: CD
authors.lastname: Kelly-Cirino
mesh_terms: D006801:Humans; D009390:Nepal; D012034:Refrigeration / Q000379:methods*; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis*
keywords: Culture contamination; Long-term sputum transport; OMNIgene SPUTUM