Increasing access to the MDR-TB surveillance programme through a collaborative model in western Kenya

Area of Science:

• Public Health
• Infectious Disease Diagnostics
• Health Systems Strengthening

Background:

• Resource-constrained settings face challenges in accessing drug-susceptibility testing (DST) for tuberculosis.
• Kenya's central mycobacterial laboratory in Nairobi is the sole facility for DST, creating diagnostic delivery barriers.

Purpose of the Study:

• To describe and evaluate a novel operational design aimed at overcoming diagnostic delivery barriers for drug-resistant tuberculosis.
• To improve access to drug-susceptibility testing (DST) for re-treatment tuberculosis cases in western Kenya.

Main Methods:

• A review of the public DST program identified barriers including lack of awareness, limited supplies, unreliable transport, and absence of specimen tracking.
• Healthcare providers at 19 clinic sites in western Kenya received training on a new diagnostics model.
• Provincial laboratory registries were analyzed to assess DST service utilization before and after program modification.

Main Results:

• The number of re-treatment specimens increased from 9.1 to 23.5 per month post-implementation.
• The proportion of re-treatment cases receiving DST rose from 24.7% to 32.5% (P < 0.001).
• The number of multidrug-resistant (MDR) TB cases identified increased from 5 to 10.

Conclusions:

• The novel operational model significantly improved the proportion of re-treatment cases receiving DST.
• Pragmatic use of existing services from multiple partners can overcome access barriers to national MDR-TB surveillance.