Overview

ASM has recently begun offering technical support to Côte d'Ivoire in order to help build the nation's capacity for tuberculosis (TB) diagnostics. This request for technical assistance was initiated in response to growing concerns regarding TB and TB-HIV co-infection throughout the country. Under the auspices of the Government of Côte d'Ivoire's Ministry of Health in collaboration with the CDC Global AIDS Program (GAP) in Côte d'Ivoire (Project RETRO-CI), the National TB Control Program (PNLT) determined that specific actions needed to be put in place in order to expand the directly observed treatment/therapy short course (DOTS). An important emphasis was placed on improving TB case detection, therefore strengthening the country's TB laboratory diagnostic capacity. This focus consists of expanding human capacity development and technical guidance for TB laboratory design and infrastructure development.
 
  
Initial Assessment, July 2007  
 
Consultant, Khye Seng Goh, Program Manager, Mah-Séré Keita Sow, and CDC partner, Dr. Linda Parsons, initiated an assessment of the country's national TB laboratory network and services in July 2007. During their assessment, Côte d'Ivoire's key stakeholders in the fight against TB-HIV met and identified three major components related to TB laboratory capacity that the ASM-CDC team was tasked to review. These included:  
  • Evaluating TB diagnostic capacity at the national/central level;
  • Assessing the feasibility of decentralizing culture capacity to regional facilities; and
  • Reviewing acid-fast bacillus (AFB) smear microscopy capacity, trainings, and external quality assessment.
Mr. Goh remained in-country for an additional week, where he provided guidance to the central level laboratory, Institute Pasteur Côte d'Ivoire (IPCI) and peripheral laboratory, Center for HIV/AIDS and Opportunistic Infection Diagnosis and Research (CeDReS) to enhance their TB culture and DST capacity. He provided recommendations to assist IPCI in renovating its TB laboratory, advised a regional Anti-TB Center in Ajamé (CAT-Ajamé) on the renovation requirements for integrating TB culture capacity in the AFB smear microscopy laboratory.
 

Laboratory Renovation Design Plans, November2007

Mr. Khye Seng Goh returned to Abidjan, Cote d’Ivoire in November 2007 to work with the leadership of the National Reference Laboratory for TB, Institut Pasteur-Cote d’Ivoire and the largest of eleven regional Anti-Tuberculosis Center Labs (Adjamé) to finalize lab renovation design plans, as well as assist with developing a list of equipment, reagent and supply needs for three national TB labs.
 

Collaboration with the Foundation for Innovative New Diagnostics (FIND), March-April2008

From March 30-April 4, 2008 in Abidjan, Cote d’Ivoire, Ms. Mah-Sere Keita Sow, led a team of representatives from the Foundation for Innovative New Diagnostics (FIND) and the World Health Organization (WHO) in introductory meetings with the CDC-Côte d’Ivoire and national stakeholders. The purpose of these in-country meetings and TB laboratory site visits was to initiate a first-time multi-organizational partnership between the CDC, WHO, ASM and FIND, in order to provide well-coordinated laboratory capacity building to resource-poor countries. The team members included Ms. Sow, Dr. C.N. Paramasivan from FIND, Dr. Veronique Vincent from WHO, and ASM consultant, Dr. Gabriel Torrea from Institute of Tropical Medicine Antwerp.

The Stop TB Partnership’s newly developed Global Laboratory Initiative (GLI) will utilize the lessons learned from this initial collaborative effort in order to develop a roadmap for accelerating laboratory strengthening through partner collaboration, resource mapping, and increased country technical assistance.
 

Acid Fast Bacilli Smear Microscopy, April2008

Dr. Gabriela Torrea returned to Côte d’Ivoire in April 2008, where she spent 3 weeks assisting the PNLT with the initial data collection and conceptualizing an improved external quality assessment program for AFB smear microscopy. 
 

Line-probe Assay Initiatives, June 2008

Following recent studies conducted by FIND together with South Africa’s Medial Research Council and the National Health Laboratory Services, the line probe assays have been found to provide reliable and feasible results under routine laboratory conditions. As a result, two new initiatives were unveiled in June 2008 by the World Health Organization (WHO), the Stop TB Partnership, UNITAID, and the Foundation for Innovative New Diagnostics (FIND). The first initiative includes the implementation of line-probe assays into the laboratory to diagnosis MDR-TB which up until now has been used primarily in research settings. This approach will minimize the waiting time to less than two days. Over the next four years, laboratory staff will be trained, laboratory facilities will be reconfigured to accommodate the equipment, and 16 countries will begin using the line-prove assay to diagnose MDR-TB. These countries will receive the tests through the Stop TB Partnership’s Global Drug Facility, which will be providing both drugs and diagnostic supplies through the $26.1 million grant. WHO’s Global Laboratory Initiative and FIND will oversee the installation and use of the new rapid diagnostic tests, ensuring necessary technical standards for biosafety and the capacity to perform DNA-based tests. Such tests will be integrated into 14 of the 16 countries between 2009 and 2011.

A second, complementary agreement with UNITAID will allow the Global Drug Facility to increase the supply of drugs needed to treat MDR-TB in 54 countries, including those receiving the new diagnostic tests. This initiative will provide $33.7 million to countries with a secondary goal of reducing the price of second-line anti-TB drugs by 2010.

Due to the initial collaboration between ASM and FIND in Cote d’Ivoire, as aforementioned, FIND included Cote d’Ivoire as one of the project countries under the FIND/UNITAID initiative. UNITAID will thus work collaboratively with all of Cote d’Ivoire’s key partners in the fight against TB/HIV and will represent a strong leveraging entity, particularly as related to the provision and procurement of essential equipment, reagents, and supplies. 
 
 

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