External Quality Assessment of Sputum Smear Microscopy in Tuberculosis Laboratories in Sughd, Tajikistan
Main Article Content
Abstract
Introduction: Tajikistan has a laboratory network with three levels of tuberculosis (TB) laboratories. The external quality assessment (EQA) of sputum smear microscopy was implemented in 2007. The objective of this study was to evaluate the EQA system and identify potential performance improvement strategies in TB microscopic laboratories in Sughd, Tajikistan.
Methods: This is a cross-sectional study based on retrospective record review and secondary data analyses on Acid-Fast Bacilli (AFB) microscopy data and EQA reading results collected between the first quarter of 2011 and the fourth quarter of 2013. Descriptive analyses were conducted to examine the overview of microscopy laboratories activities, EQA results, and laboratory performance.
Result: Of the 123,874 smears examined between 2011 and 2013, 11,522 (9.30%) were re-checked by the EQA system. The population TB screening rate rose from 0.46% in 2011 to 0.57% in 2013, and the case positivity rate decreased from 6.98% to 4.80%. The regional EQA results showed a reduction in high false-positive, high false-negative, and low false-negative errors. False-positive errors had decreased from 0.13% in 2011 to 0.07% in 2013, and false-negative errors from 0.91% in 2011 to 0.15% in 2013. Regional sensitivity of smear microscopy, when compared to re-checking controller, increased from 88.2% in 2011 to 97.2% in 2013. The regional specificity level remained relatively stable at above 99%.
Conclusion: Our study found that a decreasing trend of case positivity rate from 2011 to 2013 in Sughd, though the overall laboratory workload was on the rise. In addition, EQA results showed an overall error reduction and an improved sensitivity of smear microscopy in the region. The overview of microscopic laboratory activities and the actual evaluation of the EQA system on sputum smear microscopy complement each other in providing a better picture on the progress of TB laboratory strengthening. We recommend similar approaches to be adapted by future evaluations on TB microscopic laboratories, particularly among countries of high burden. Interactive training and feedback loops are crucial to improving TB surveillance in Tajikistan.
Article Details
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.
References
WHO. Global tuberculosis report 2014. 2014.
New diagnostics working group of the Stop TB Partnership. Pathways to better diagnostics for tuberculosis. 2009; http://www.finddiagnostics.org/export/sites/default/resource-centre/reports_brochures/docs/BluePrintTB_annex_web.pdf. Accessed December 12, 2014.
The Global Laboratory Initiative. A Roadmap for Ensuring Quality Tuberculosis Diagnostics Services within National Laboratory Strategic Plans. 2010.
TB Care I. International standards for tuberculosis care. 2014.
Ridderhof J, van Deun, A, Kam, M, Abdul, M. Roles of laboratories and laboratory systems in effective tuberculosis programmes. Bull. World Health Organ. 2007(039081):354–359.
Korobitsyn A, Mohr, T, Ismoilova, ., Trusov, A, Mohr, T. TB case detection in Tajikistan - analysis of existing obstacles. Cent. 2013;2.
Edwards P, Wyss, K. Management of pulmonary tuberculosis in Tajikistan : which factors determine hospitalization ? Trop. Med. Int. Health 2008;13:1364–1371.
WHO. Tuberculosis country profiles. http://www.who.int/tb/country/data/profiles/en/. Accessed December 12, 2014.
Agency on Statistics under President of the Republic of Tajikistan. The population of the Republic of Tajikistan on 1 January 2013. 2013; http://stat.tj/en/img/36a268df28cfe07c2098351a71bb2773_1372996986.pdf. Accessed December 12, 2014.
Aziz M, Ba, F, Becx-Bleumink, M, Britzel, G. External quality assessment for AFB smear microscopy. 2002; http://stacks.cdc.gov/view/cdc/11440. Accessed December 12, 2014.
Ayé R, Wyss, K, Abdualimova, H, Saidaliev, S. . Illness costs to households are a key barrier to access diagnostic and treatment services for tuberculosis in Tajikistan. BMC Res. Notes. 2010;3:340.
WHO. Systematic screening for active tuberculosis principles and recommendations. 2013; http://apps.who.int/iris/bitstream/10665/84971/1/9789241548601_eng.pdf?ua=1. Accessed December 12, 2014.
National Program for tuberculosis protection of the population of the Republic of Tajikistan for 2010-2015. 2009.