one-STOP TB-service Печать

Breakthrough concept

 

Полумобильная контейнерная ТБ лаборатория даeт возможность диагностирoвaть туберкулез 20 различными методами в условиях одного 20-футовoго контейнерa. Таким образом "One-Stop TБ-Сервис" существенно снижает стоимость и время диагностики пациента.

Current case detection strategies in Sub-Sahara Africa are often inadequate to control TB in the general population and even more so in risk groups.

The CTBL will incorporate new and existing technologies used in the detection and diagnosis of TB today. The “one-Stop TB-service” concept is to incorporate new and existing technologies used in the detection and diagnosis of TB today. These technologies can be integrated into a revolutionary new “platform” for use  at the place where the patient is, the Point Of Care (POC).

New TB diagnostic tools at (primary) health facilities should be:

  • Easy to operate; one of the biggest challenges African health care faces is the lack of skilled health care workers.
  • Integrated in DOTS program, so linked to TB treatment services including proper registration and treatment follow-up.
  • Possible to integrate in the existing Health Service System.
  • Preference should be given to diagnostics which can be used for the detection of multiple diseases and contribute to Health System strengthening.
  • “Economic”, not only calculated as the total cost of the test, but also taking into account the patient gain from faster, better and more integrated diagnosis.
  • Integrate diagnostic imaging with sputum microscopy.
  • Act as a platform for new techniques for the diagnosis and treatment of HIV/AIDS, Malaria and TB.

The CTBL designed in Zambia with support from Zambart and the National TB Control programme consists of a standard size 20 foot container, to be placed at POC or at district hospitals using any local available truck able to transport a 20 foot container. With an integrated lifting device the unit can be placed and become operational in just 2-3 hours at (almost) any venue thinkable. The unit will be self supporting in terms of electrical power (power generator) and water for a period of time allowing operation even when such utilities are - short term -not available. Integration of an (information) system and database for laboratories, X-ray and other health services could prove to be beneficial for national TB programs, for instance for use in a TB prevalence survey, and screening programs.

Layout of the Containerized TB Lab (CTBL)

 

The CTBL unit is internally divided into three parts and two folding screens provide additional external space

  • Chest X-ray room. In this room the digital X-ray unit is placed and patients are X-rayed in an upright position (PA/LAT)
  • Chest X-ray control area. In this room the radiographer will enter patient data, make the Chest image and will give an onsite diagnosis with support from the CAD4TB protocol. A hardcopy print-out can be given to the patient for further reference at a cost of U$D 0,03 per print.
  • Lab area. In this well ventilated   room the sputum samples will be processed. The room will contain a LED Fluorescent microscope and/or a molecular based TB diagnostic test (Xpert)
  • On both sides of the container two fall-out screens are mounted, providing shelter and a separate waiting and  sputum collection area for the suspects and patients. The screens are stored in an enclosed compartment during transport.
  • A special lifting device is integrated at the four corners which allows for easy up and offload of the unit from a standard size truck without the need for a separate crane.Description of CTBL Technology
  1. Direct digital X-ray unit (DR). Chest radiography (CXR) is becoming increasingly important in the diagnosis of TB especially in high HIV prevalence areas. Not only is CXR important to detect TB in HIV cases it is also an indispensible tool to realise universal access to TB care by finding more patients earlier. However, less experienced readers have difficulties in interpreting signs on a CXR. To enhance accuracy in image reading, the latest Digital Radiology concepts allow sending images over internet or mobile phone networks. On top of this a second opinion through computer-aided diagnosis (CAD) of TB suspects, automatically indicating location and probability of abnormalities consistent with TB will significantly reduce over and under-reading.

  2. Optimized Smear Microscopy. Fluorescence staining and sputum processing can increase the sensitivity of smears. LED based microscopy is simple and available at access pricing for resource limited settings. Optimized Smear Microscopy is known to increase the sensitivity of TB smears but is currently not widely available at POC.
  3. Xpert (Cepheid). This is a rapid system for the detection of M. Tuberculosis and of Rifampcin resistance. The system works direct on sputum samples and provides a result in just two hours and combines sample preparation with amplification and detection in a cartridge based system. The same technique can be used for numerous other diagnostic tests and because it is a closed loop system can be performed in just one room. Availability of PMDT (programatic management of Drug Resistant TB) and access to MDR treatment is required.
  4. Integration of communication/database system: The unit will make use of the so called African Access Point (AAP’s), a combination of wireless and GSM techniques which allow users to communicate with the unit through standard mobile phones. This will be useful in gathering patient data and treatment follow up in the communities. Communication between the unit and a central database will go through GPRS/EDGE and if available UMTS techniques. The AAP system can also be used to facilitate access to e-learning modules for the operating staff.
  5. Health System Strengthening. By linking TB control activities to respiratory health, TB programs can improve the overall quality of healthcare. In this respect access to high quality CXR will be prove to be an invaluable tool in the year of the Lung and onwards. As mentioned before, access to TB treatment for registered patients is a critical success factor for effective use of the platform. External Quality Assessment is to be budgeted for.
  6. Human technology. Although sophisticated technology is used, the platform is designed with a low resource setting in mind. All diagnostic techniques and tests are easy to operate and require basic training. Use of mobile phones is already widely accepted and the information system is Windows based.
  7. Advocacy. The one-Stop TB-service when communicated under a more general Lung Health program and brought close to the community, can reduce barriers to TB care. Most people are willing to get their X-ray taken and are more likely to accept to undergo additional testing if the CXR is considered to be abnormal.