World TB Day 2022
24 March 2022
Did you know that the Mycobacterium Reference Laboratory (MRL) at SA Pathology is recognised by WHO as a Supranational Reference Laboratory, and it is the international reference laboratory for Indonesia, Vietnam, Kiribati, and the Solomon Islands?
SA Pathology’s comprehensively illustrated expert information for technicians overseas, The Handbook, was also chosen by WHO and the International Union against TB and Lung Disease when they wanted to consolidate their TB microscopy training documents in 2014.
For over twenty years, Lisa Shephard, and her predecessor, Richard Lumb, have provided ongoing support to overseas laboratories.
"[They’ve been] making visits and helping the countries improve their laboratory services, both for microscopy, TB culture and susceptibility testing - to see which drugs work against the TB.
Because of the requirements of those countries, we have also helped them design their new laboratories", Dr Ivan Bastian says.
They have also helped, particularly in Indonesia, with the rollout of commercial GeneXpert machines (produced by Cepheid P/L ® and endorsed by WHO. The Xpert machines can detect TB quickly via a molecular test and discover if a case of TB is rifampicin-resistant (a key treatment drug).
Indonesia & Vietnam have become largely self-sufficient through efforts in-country with assistance especially from Richard Lumb. COVID-19 has provided fresh challenges for the TB laboratory here at SA Pathology, and Lisa Shephard has led the coordination of efforts to adapt.
"Our role has changed to more of a support role rather than on-the-ground training, certainly in Indonesia and Vietnam. So we do still have our links with those countries but unfortunately we can’t visit, which has been a real challenge. We’ve still been able to support by sending isolates for testing to ensure their laboratories are still quality assured and performing.”
Ms Shephard also believes that the role of our laboratory is different with Kiribati and the Solomon Islands due to their limited resources and inaccessibility.
She was unsuccessful in her attempts to continue microscopy quality assurance due to transport difficulties during the COVID pandemic; however, she was able to keep the vital GeneXpert instrument operational by ensuring cartridges were sent on the government chartered flight.
The Solomon Islands flights are now resuming, and Ms Shephard looks forward to re-engaging with the local team.
It isn’t just transportation that has been an issue.
The GeneXpert instrument mentioned earlier can also perform COVID testing, meaning many of the machines have been “commandeered”. Many staff have also been re-deployed to help address the pandemic.
This re-deployment of resources means undiagnosed TB cases have increased. Last year, WHO estimated more than 4.1 million cases were undiagnosed. Dr Ivan Bastian believes it is now time to start “playing catch-up”.
TB isn’t just a problem overseas though, “I think people are surprised that we do about 11,000 samples a year testing in South Australia”, Ms Shephard explains.
There are 70-80 new TB cases a year in South Australia.
Australia’s case numbers have plateaued for the last two decades, but largely, the cases are coming from migrant populations from TB endemic countries.
Dr Ivan Bastian believes, “it is all about early intervention in these migrant communities. So early diagnosis of active disease and latent TB infection will be key”
He says that preventative treatment will be a major focus moving forward once practicalities are addressed.
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