Experience establishing tuberculosis laboratory capacity in a developing country setting

Area of Science:

• Public Health
• Infectious Disease Diagnostics
• Laboratory Medicine

Background:

• Lesotho faces a high prevalence of tuberculosis (TB), co-infection with human immunodeficiency virus (HIV), and a significant burden of multidrug-resistant TB (MDR-TB).
• Existing laboratory diagnostic capacity for TB was limited in this resource-constrained setting.

Purpose of the Study:

• To describe the process and outcomes of strengthening laboratory diagnostic services for TB in Lesotho.
• To assess the feasibility of implementing modern TB diagnostic methods in a resource-limited environment.

Main Methods:

• A collaborative effort involving international organizations renovated the National TB Reference Laboratory in Lesotho.
• Services were enhanced, including microscopy, conventional culture, drug susceptibility testing (DST), and the introduction of molecular diagnostic techniques like line-probe assay.
• A biosafety level three facility and external quality assessment programs were established.

Main Results:

• The establishment of a biosafety level three facility and external quality assessment program was feasible within four months.
• Liquid culture, DST, and line-probe assay for rapid MDR-TB detection were successfully implemented.
• Preliminary diagnostic results were comparable to those from industrialized countries.

Conclusions:

• Strong political commitment and collaboration enabled the rapid establishment of quality-assured TB diagnostic capacity in a resource-limited setting.
• The initiative significantly enhanced the detection and management of TB and MDR-TB cases.
• The experience serves as a model for modernizing laboratory services and translating policy into practice in developing countries.