National Guidelines for Culture and Drug Susceptibility Testing

Prompt diagnosis of both drug-susceptible and DR-TB cases is the first step to achieving TB control. A strong and efficient laboratory network, providing diagnosis according to the established diagnostic algorithm and under quality assured procedures is the key component for this task. The role of laboratories at different levels includes services for the management of individual patients, programmatic activities which includes monitoring trends of drug resistance, and surveillance. The laboratory network is coordinated at the central level by the laboratory team of the NTBLCP. The diagnosis of DR-TB patients (defined here as rifampicin-resistant and Multidrug-Resistant TB (MDR-TB)) is currently based on examination of presumptive DR-TB cases using GeneXpert MTB/Rif or Line Probe Assay (LPA). Sputum specimens from presumptive DR-TB cases are collected from Directly Observed Treatment Short course (DOTS) centres and transported to GeneXpert sites for examination. Currently, all 36 states and the Federal Capital Territory (FCT) have at least one GeneXpert machine for diagnosis of TB and/or resistance to rifampicin. Transportation of specimens from the DOTS centres to the GeneXpert sites is the responsibility of the Local Government TB and Leprosy Supervisor (LGTBLS). Following a positive result for drug resistance by GeneXpert or LPA, sputum specimen is collected for confirmatory TB culture and Drug Susceptibility Testing (DST) for first line anti- TB drugs prior to commencing the patient on treatment.