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Discussion: Considerations for and continuity of tuberculosis (TB) care during the COVID-19 pandemic

Following release of the World Health Organization (WHO) Information Note on considerations for tuberculosis (TB) care during the COVID-19 pandemic, the Uganda NTRL / WHO SRL Kampala organised and modulated a Zoom teleconference with laboratory managers and other laboratory staff to discuss the new guideline issued by WHO on considerations for TB care during the COVID-19 pandemic.
The teleconference took place on Thursday, 9th April 2020 at 11:00am East Africa Time (EAT), and was attended by more than 50 participants from Uganda, and other countries Ain the East, Central and Southern African Region especially those supported by Eastern Central and Southern Africa Health Community (ECSA-HC) and SRL under the Global Fund Regional TB Laboratory Strengthening project. The teleconference was also attended by representatives from WHO Regional Office for Africa (WHO-AFRO) and ECSA-HC.

Discussion Agenda
1. Welcome Remarks from Director, Uganda NTRL/ WHO SRL Kampala
1. Presentation by Uganda NTRL/WHO SRL Kampala on WHO guidelines for continuity of TB services during the COVID-19 pandemic
3. Feedback and Experience sharing from different countries and laboratories
4. Conclusion and Way forward

Participants appreciated the discussion and described it as timely. Safety of the laboratory staff was one of the key concerns that came out strongly and participants discussed various possible approaches in line with the WHO guidance. For more details about the discussion, you can listen to the recorded audio session here and download the session presentation here.

Below is a listing of key concerns raised and respective response shared.

No CONCERN RESPONSE
1. Risk allowance for Health Workers This is beyond the scope of this conference call. However we shall share your concern with the respective offices
2. How to perform AFB smear microscopy at lower health facilities without biological safety cabinets AFB smear preparation and staining is considered a low risk procedure that can safely be performed on an open bench with adequate ventilation without the necessity of a biological safety cabinet.
3 Should COVID 19 be tested at a health facility without a BSC? NO-this should not be encouraged. Refer the sample to a site with a certified functional BSC
4 Can a conventional genexpert machine be used to test for COVID 19? YES-By installation of the assay definition file and use of the specific COVID 19 cartridge.
5 a.       Evidence about the efficiency of a gloves box in relation to COVID 19?

b.      Would this be an option to a BSC

a.       We may not have this evidence/research since COVID 19 is a new pandemic with a lot to be learnt.

b.      This would not be an option in the short run because the benefits of the HEPA filters in the BSC would allow it to be used even without being ducted while with the gloves box the air has to be directed/ ducted out of the room.

6 Will COVID 19 samples be tested in the same labs doing routine-diagnosis? Some of them may not even have BSCs. YES-But this may not be fully decentralised to all laboratories but only those that would have fulfilled all the assessment requirements (including safety)
7 N95 respirators are not available in some settings; hence TB samples are not being processed for either genexpert or AFM smear microscopy Both genexpert and AFB smear preparation and staining are considered a low risk procedures by the WHO; hence these can safely be performed on an open bench with adequate ventilation without the necessity of N95 respirators.
8 Refresher trainings about biosafety in TB laboratories Each institution should locally plan local refresher trainings in biorisk (biosafety and biosecurity) management.

If no local (institution biosafety officer) trained expertise is available then plans should be made with the Implementing Partners to have an arrangement made either by the district Lab Focal Person or with CPHL safety office. (response applicable to Ugandan audience)

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Use of bleach concentration techniques for AFB samples to reduce transmission. Yes-BUT from the risk assessment this may not be very necessary just as mentioned for 2 above.

Other key WHO resources shared can be accessed on below links;

You can also contribute to the discussion by adding your views or any feedback in the comments section below and it will be viewed

Adjustment in Operations at Uganda NTRL/SRL during the COVID-19 Threat Period

Download Uganda NTRL-SRL COVID Memo March 2020

The World Health Organization declared COVID-19 a pandemic which is rapidly spreading across many countries including Uganda. This therefore compelled the government of Uganda to institute necessary measures to control the spread of the virus and keep all Ugandans safe.

The NTRL wishes to continue with service delivery as well as ensuring that all Presidential directives and Ministry of Health guidelines are strictly adhered to for the safety of all. In this regard the Uganda NTRL/SRL will be working with reduced workforce at any given point in time – as part of the safety precautions.

Therefore, the adjustments in operations may affect the Results’ Turn Around Time (TAT) across all the tests offered at the NTRL/SRL. This implies that clients’ result reports dispatch is anticipated to take longer than our standard stipulated times, during this entire period.
We kindly request all to bear with this temporary arrangement and assure you that when the situation gets back to normal, communication will be sent out to that effect. We will keep you updated.

We apologize for any inconvenience. STAY SAFE!

MOH TB HIV

Uganda Ministry of Health Launches 100 Day Plan to Scale up Tuberculosis Treatment among People Living with HIV/AIDS

MOH TB HIVKampala – 03 July 2019- Approximately 300,000 People Living with HIV/AIDS (PLHIV) will be initiated on Tuberculosis Preventive Treatment in July 2019. This was revealed during the launch of the 100 day accelerated Isoniazid Preventive Therapy (IPT) scale up plan in Kampala.

While launching this accelerated plan, Minister of Health, Hon. Dr Jane Ruth Aceng said that Uganda has borne disproportionate burdens of HIV and Tuberculosis (TB) over the years. Dr Aceng highlighted that the number of new HIV infections were estimated at 53,000 in 2018 compared to 130,000 in 2010. There was a decline in AIDS related deaths from 60,000 in 2010 to 26,000 in 2018.

“Our statistics indicate that annually 83,000 cases of TB occur, but only 50 percent of them are diagnosed and started on treatment” Dr Aceng noted. “For the HIV epidemic, the Ministry of Health and partners, have over time implemented HIV prevention and treatment interventions that have resulted in significant epidemic contraction in the last five years” she added, however “these achievements contrasts with the big burden of TB that continues to be reported in the country.”

The launch took place in three-fold aiming to raise awareness in preventing the two epidemics; HIV and Tuberculosis in Uganda, implementation of evidence based interventions to control the two epidemics and mobilization of key stakeholders.

According to the global 2018 UNAIDS report, 32% of AIDS related deaths were a result of Tuberculosis. Justifying the need for TPT, Dr Aceng  pointed out that “these needless deaths can be prevented using a low-cost medicine- isoniazid, that lowers the risk of suffering from TB by up to 60% among people living with HIV.”

She further said that Isoniazid Preventive Treatment has been shown to work synergistically with anti-retroviral treatment (ART) to reduce the incidence of TB among PLHIV. “For the prevention of tuberculosis among PLHIV, we are therefore prioritizing the scale up of Isoniazide prophylaxis” she said.

The overall goal of the 100-Day Accelerated IPT Scale Up Plan is to Enroll 300,000 PLHIV on isoniazid preventive therapy, scale up IPT initiation of children living with HIV and under-5 TB contacts at 1,947 AntiRetroviral Therapy (ART) sites and ensure 100% completion by 30th September 2019.

Specifically, the plan will mobilize a DHO- led multi-stakeholder engagement for accelerated IPT implementation and increased accountability, enhance IPT completion rates to 100% of individuals that initiated on IPT in the quarters of  October to December 2018, and January-February 2019. Furthermore, the plan will enhance systems for IPT delivery, monitoring and reporting of IPT outcomes.

The US Ambassador to Uganda, Deborah Malac lauded Government of Uganda for launching an ambitious plan and moving in the right direction. “Great achievements needs ambitious plans and Uganda has a good record in achieving high targets” she noted.

The World Health Organization (WHO) Country Representative, Dr Yonas Tegegn Woldemariam called for improved collaboration across health programs for harmonized and integrated policies and service delivery. He noted that this will help in achieving prevention, timely diagnosis and treatment of TB among PLHIV.
Dr Tegegn, however said that “unless HIV programs scale up interventions to close these gaps in prevention, diagnosis and treatment, we will not meet our common targets – we cannot reduce HIV mortality without addressing the main cause: TB.”

The Permanent Secretary, Dr Diana Atwine said “in last two weeks prior to the launch we have noted exponential increase from as low as 4000-5000 per week to over 10000 PLHIV on IPT in the last week. This is a sign that it is possible to reach all our PLHIV and children under 5 years of age who are contacts of TB patients with this life saving intervention.” Dr Atwine appealed to all District Health Officers (DHOs) to take lead and ensure all PLHIV and contacts of TB patients start on the preventive therapy.

The Government of Uganda continues to scale up of combination HIV prevention interventions including structural, behavioural and biomedical interventions. The Ministry of Health is  implementing a public health response focusing on the Fast Track interventions for epidemic control by 2020 and ending AIDS by 2030. Similarly, for Tuberculosis, Ministry of Health focuses on TB prevention interventions as well as intensified case finding and treatment.

Original Post appeared on MOH Website

Consultancy Advert – Developing a Communication and Visibility Plan for Uganda SRL

The ECSA-HC invites proposals from eligible, qualified and experienced consulting firms for provision of consultancy Services to develop a Communication and Visibility Plan for Uganda-SRL for a duration of 1 year. The objective of the assignment is to develop and implement a Communication and Visibility Plan for Uganda-SRL and the ECSA Global Fund Regional TB Laboratory Strengthening Project. Download detailed information here.

Uganda TB Supranational Laboratory Supercharges Fight against TB in East Africa

In a high-security building in Kampala, Uganda, a man leads a group of sleuths investigating a potential killer. While they may go about their work with the meticulousness of police detectives, they are actually a different type of investigator. Professor Moses Joloba, Director of Uganda’s Supranational Reference Laboratory, leads his team to pursue TB – the world’s leading killer among infectious diseases. The disease killed more than 1.6 million people around the world in 2017.

Tuberculosis is an ancient disease, but it will take the best of modern diagnostic technology to end it as an epidemic. Some TB tests can be complicated and expensive, and require complex laboratory facilities, which are more sophisticated than what most clinics can offer.

Uganda’s Supranational Reference Laboratory plays a pivotal role in bringing both tech and training to many countries. It is a “supranational” lab because it supports 21 countries across Africa to conduct complicated TB tests. It also supports the countries’ national TB reference labs, guiding them to achieve WHO accreditation. With this work, Uganda is leading the charge in advancing health security in Africa.

“We serve as a demonstration site. This is peer-to-peer learning, where the countries that face the same challenges as we do can learn from us,” says Joloba. “TB reference managers come here, we train them, we mentor them, and we challenge them. They go back to their countries motivated and empowered.”

The work of the lab he manages is helping many countries in Africa to mount a strong fight against TB, while guiding them to build resilient and sustainable systems for health. Experts from the Uganda lab also visit other countries and support staff in their home laboratories.

The program is a partnership between the Uganda National Tuberculosis Reference Laboratory, the East, Central and Southern Africa Health Community (ECSA), and the Global Fund:. the Global Fund provides the funding, ECSA serves as the principal grant administrator, and the Uganda national TB lab runs the operations of the laboratory. Together, this partnership – which brings together technical, financial and logistics expertise – is transforming the fight against TB in Africa.

The Uganda lab achieved the status of supranational reference laboratory, making it the third such facility in Africa, after labs in Algeria and South Africa. In the five years since the Uganda lab achieved accreditation, it has built a strong network of labs in the region, improving services, providing technical support and training lab technicians across the region.

The countries currently supported by the Uganda lab include: Kenya, Eswatini, Somalia, Eritrea, Tanzania, Mauritius, South Sudan, Angola, Rwanda, Namibia, Zambia, Zimbabwe, Botswana, Seychelles, Mozambique, Malawi, Burundi, Lesotho, Liberia and Djibouti.

Four of these countries – Mozambique, Tanzania, Namibia and Kenya – have now reached WHO accreditation status.

Prof Moses on Africa Map

 

With that success, the work of receiving and testing samples from countries has declined. More labs in the region can stand on their own, and do their own tests in their own countries. Today, only about 10 percent of samples tested in the lab come from outside Uganda. It is a development that pleases Joloba.

“We are happy more countries are gaining full capacity to conduct their own tests,” says Joloba. “We want to get ourselves out of the business of testing samples from other countries. Our target is to mentor these countries to be independent of us.”

The Permanent Secretary in the Ministry of Health in Uganda, Dr. Diana Atwine, has great praise for the work of the lab and its personnel. “The TB lab is not only giving us super-specialized services, it is also spreading the best practices across East Africa and beyond,” says Dr. Atwine. “They have mentored lab workers in this country and across the region. They are offering first-class services, training and research.”

lab tech at ug srl

 

 

 

Primary Source: The Global Fund

National TB Conference 2018: Stakeholders call for increased domestic funding towards Tuberculosis

Kampala – 14/08/2018– Uganda remains among the high TB/HIV burden countries in the world. The country conducted the first national population-based TB disease prevalence survey in 2014/15 which estimated the prevalence of TB at 253/100,000. The survey also showed that Tuberculosis caused 80,000 new cases much higher than HIV (60,000 new cases).

Speaking during the 2nd Annual National TB Conference at Imperial Royale in Kampala, Minister of Health, Hon. Dr. Jane Ruth Aceng noted that “TB is made and treated in the community and a lot needs to be done to find the missing TB cases”. While there is a growing threat of Multi- Drug Resistant (MDR) TB, “the country is notifying only 26 % of the estimated MDR-TB cases. In 2017, 489 MDR-TB cases of the estimated 1900 cases that occurred were detected” she said. 

Government of Uganda has invested in new diagnostic technologies like the Gene Xpert machines. “We now have 249 functional Xpert machines spread out in 227 health facilities covering all districts in the country” Aceng informed, as she spoke about the interventions the Ministry is undertaking in the fight against TB. The utilization of these equipment has improved to 9.1% tests per day, however, this still falls short of the expected 12 tests. 

The Ministry of Health has also made available free TB treatment with shortening of the treatment period for both sensitive and resistant TB of up to 6 and 12 months respectively.  “There is however stagnation in TB treatment outcomes with a poor treatment success rate of just 70% far below the national and global targets” Aceng lamented.

As part of the future plans and efforts in the fight against TB, Hon. Aceng noted that “Use of the Emergency Operational Center (EOC) helped us in achieving elimination of Mother to Child transmission of HIV. The same approach will be employed for key TB indicators until all of us at District level reach desired performance levels” she said.

“In an assessment of TB service delivery at selected facilities early this year, a number of barriers at the facility were identified including; a health workforce with inadequate knowledge on TB diagnosis and management. In an effort to improve health work confidence and skill in TB diagnosis and management, the Ministry will roll out a training cascade in TB management and dissemination of national guidelines to reach relevant management and frontline health workers” Aceng noted.

The World Health Organization (WHO) Country Representative, Dr. Yonas Tegegny noted that strong partnerships and commitment are required to end the TB epidemic at every level. 

Tegegny, however called for reflection on;
•    Improved case detection and reporting since most of existing TB cases are being missed by the health systems
•    Improving treatment outcomes for the identified TB cases
•    The high levels of TB/HIV co-infections among our people
•    The rising trends of multi-drug resistant TB cases
•    The inadequate financing of Health as a whole in Uganda and towards TB in particular
The US Ambassador to Uganda, Deborah Malac noted that the US Government invests more than $500million annually in Uganda’s health sector. “However, I urge the Government of Uganda to increase domestic funding for TB and craft policies that will help Uganda succeed in ending the TB epidemic for good” Malac said.

“Through its collaboration with Ministry of Health, the 5 year USAID-Defeat TB Project has increased the number of new TB cases by 15% reported in the Kampala, Wakiso and Mukono Districts” Malac informed. 

Malac further added that as part of the efforts by the US Government in ending TB Epidemic in Uganda “USAID signed an implementation letter with the Ministry of Health specifying the roles and responsibilities of each stakeholder in reducing the TB burden in Uganda” she said. She applauded Uganda for this promising step in ending the TB epidemic.

While the country has made some achievements in the fight against TB, the two Day Conference held under the theme “Striving towards a TB Free Uganda through finding the Missing Cases- Act to End TB Today” called for increased allocation of resources and domestic funding towards TB – a plea that remained loud.

Source: Ministry of Health

Job Advert – Finance Officer

Finance Officer Job Advert [Deadline: 14th May 2018]

The East, Central and Southern African Health Community (ECSA-HC) invites applications for the Post of Finance Officer from suitably qualified persons who are Ugandan nationals. The position is tenable at the National TB Reference Laboratory, Kampala-Uganda. Details are here

NTRL Holds a team building event for staff

NTRL Staff in Team building activity
On Friday March 02, 2018, all NTRL staff gathered together at NTRL Butabika in a team building event aimed at fostering closer relations and enhancing engagement amongst them. The full day event was organised by the laboratory management and saw a variety of fun and engaging activities that were intended to help the staff appreciate the dynamics of team work and also be aware of the behaviours necessary to foster productivity at the work place.

Unlike other corporate team building activities that focus on sufficient relaxation, this kind of NTRL’s team building activity brought to life the theme of “Achieving attractive workplace behaviours regardless of individual differences in teams”. “The reason we decided to go this direction of such a theme is because we desire to empower all staff and train more team leaders that harness their colleagues’ unique skill sets and thus help to reduce workplace stress at a structural level”, said Denis Oola, The NTRL Operations Officer, who represented Management. He added that Management is committed to organising more of such events for its staff.

The staff was so grateful for the best offer by management at such a first quarter of the new year, and also promised to translate the knowledge and awareness gained into behaviours that will foster a productive and stress-free environment at NTRL.

IMG-20180302-WA0014

IMG-20180302-WA0042

CDC Uganda Country Director visits UNHLS/NTRL

CDC Country Director at NTRL-UNHLS

The new CDC Uganda Country Director, Dr. Lisa J.Nelson, paid a courtesy visit to UHNLS and NTRL on 18th January 2018 to acquaint herself with the work done by the laboratories. She was very pleased with what was happening especially, the accreditation status of the two laboratories at NTRL and CPHL.

During the visit, she was glad to know that NTRL is a Supra-national Laboratory serving 23 other countries in Africa as far as quality control is concerned. She was also happy to note that services in CPHL are giving quality results to Ugandans in the remote country side.

Dr. Lisa urged UNHLS/NTRL staff to write their successes and best practices and publish them for the outside world to know.