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BSL2 & 3 tuberculosis laboratoies

By Abdulwahab Binjomah | 23 Feb, 2017

Dear all,

We are planning to develop tuberculosis diagnostic laboratories to reach the stndarised level in terms of infrastructure, tools (diagnostic tests), scope of services, policies, manpower and mainly designs of BSL2 & BSL3 tuberculosis laboratories. Actually, I went trough the WHO & CDC documents but I couldn`t find that much to support me in these areas. Hence, could you suggest references that can guide me in doing this work please?

Many thanks

Replies

 

Jean-Francois de Lavison Replied at 7:25 AM, 23 Feb 2017

Intresting, you can share it with:
WHO: Mario Raviglione: WHO Director, Stop TB Department
Stop TB: Dr Lucica Ditiu, Executive Director of the Stop TB Partnership
Unitaid: Philippe Duneton: Advisor to the Executive Director
Find could also be interested: Claudia Denkinger: Head of Tuberculosis and Hepatitis Program

Willy Ssengooba Replied at 7:33 AM, 23 Feb 2017

The journey to a functional BSL-3 facility may be long or quite short depending on the implementing country.

Rule; Visualize the entire process and plan before getting started on the process.

Some usual challenges from my experience;
-Financial; Cost should be informed by the architectural design and Bills of Quantities
• Get a competent engineer or a ventilation expert. In my country, very many will tell you they can do the job, but very few with experience in BSL-3 construction. Most of the time they end up underestimating the work. The cost for construction of a safe TB culture lab are so high and many times prohibitive.
• Prefabricated labs may be a cheaper, rapid, short time solution for countries without TB culture labs, however, they have limited capacity.
- There are procurement challenges;
Design/consultant procurement, Constructor procurement, Certification procurement. Each of these is lengthy process combined with lack of company having all of the required competencies.

- Maintenance challenges; local team to maintain the facility after construction. You may consider a plan to have the contractor train your local people to maintain the facility, more so the ventilation and power supply units as well as managing the unexpected breakdowns.
-
Bottom-line: Better to learn from countries with functional BSL-3, Use people with proven competencies at each stage, from design. Choose a design that is robust to minimize frequent breakdowns, limit accessories to only those that are very vital, secure budget for maintenance's and have maintenance budgets.

You may also get some information in the article below;
Ssengooba W, Gelderbloem SJ, et al: Feasibility of establishing a biosafety level 3 tuberculosis culture laboratory of acceptable quality standards in a resource-limited setting: an experience from Uganda. Health research policy and systems / BioMed Central 2015, 13(1):4.

Abdulwahab Binjomah Replied at 10:39 AM, 23 Feb 2017

Dear all, thank you for the quit useful information

Rahul Narang Replied at 11:27 PM, 23 Feb 2017

Dear Dr Abdul,

It is a good news that you are contemplating setting up BSL-2 and 3 laboratories for Saudi Arabia.

You may go ahead in the following process and by answering certain questions-

1. How many laboratories will be required depending upon the population and number of TB patients of regions. Also, decide if you want to go in a phased manner, up-scaling the services. You may invite experts to assess situation in your country.

2. Secure funds for this process- I understand this you must have done beforehand.

3. Infrastructure development- decide if you want to create new infrastructure or renovate the existing structure. For this purpose, you need vendors who can develop this for you. FIND has experience in setting up such laboratories in low/middle income settings including India and those laboratories have been functioning well. However, for FIND also deciding on the vendor and getting the work done in government sectors has been a challenging task.

4. Equipment and reagents: This is another challenging task. List of these items is available; however, supply chain management may be difficult. I understand that at your country level it may be managed if you plan well.

5. Training of HR- This is very important step and you may need hand holding of your trained HR for proper functioning. Another important issue is retaining your trained HR.

6. Quality Management- This step has to be thought beforehand by consulting Supranational Lab for your country.

7. Service delivery - This includes sample transportation, testing and delivery of results. Sample transportation needs proper referral linkage and may be difficult in not planned properly.

I have shared the above information based on my experience working with FIND, Govt. of Ethiopia and Ethiopian Public Health Institute, Republic Djibouti and Government of India, National Tuberculosis Institute and International Center of Excellence for Laboratory Training.

Thanks and regards.

Rahul Narang

Chaitali Nikam Replied at 6:50 AM, 26 Feb 2017

Dear Dr. Abdul,
Please find trailing link to summarize some important aspects.
https://www.aphl.org/conferences/proceedings/Documents/2013/2013-National-TB-...

Totally agreed with Dr. Rahul.

Best
Chaitali

Chaitali Nikam Replied at 6:55 AM, 26 Feb 2017

Dear Dr. Abdul,
Please find trailing link to summarize some important aspects.
https://www.aphl.org/conferences/proceedings/Documents/2013/2013-National-TB-...
Totally agreed with Dr. Rahul.
Best
Chaitali

Abdulwahab Binjomah Replied at 8:24 AM, 26 Feb 2017

This is quit useful.
Thank you so much

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