Does task shifting in tuberculosis microscopy services to non-certified technicians in Afghanistan affect quality?

Area of Science:

• Medical diagnostics
• Public health
• Laboratory science

Background:

• Tuberculosis (TB) diagnosis relies heavily on sputum smear microscopy.
• Ensuring quality microscopy services is crucial, especially in resource-limited settings like Afghanistan.
• The role of certified versus non-certified technicians in TB microscopy quality is an important consideration.

Purpose of the Study:

• To compare the quality of sputum smear examinations performed by certified laboratory technicians versus non-certified technicians (high school graduates) in Afghanistan.
• To assess the impact of technician certification on the accuracy of tuberculosis microscopy.

Main Methods:

• A cross-sectional record review of sputum smear microscopy slides was conducted.
• Slides were examined by technicians and cross-checked by trained assessors as part of external quality assurance.
• Data were collected from 386 microscopy centers across 30 provinces between July and September 2009.

Main Results:

• A total of 7313 slides were reviewed from centers with certified and non-certified technicians.
• 16% of centers with certified technicians had major errors compared to 18% of centers with non-certified technicians.
• No statistically significant difference in major error rates was observed between the two groups.

Conclusions:

• The performance of non-certified microscopy technicians in sputum smear microscopy is comparable to that of certified technicians.
• This study validates the deployment of non-certified technicians in peripheral health centers for TB diagnosis in Afghanistan.
• Quality assurance in TB microscopy remains essential regardless of technician certification level.