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.

(Commenting has now been closed)

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!