In-depth: TB - the year that was

ZAMBIA: Better health comes in containers

Photo: Laura Lopez Gonzalez/IRIN

Making TB technology more accessible

LUSAKA, 26 January 2011 (PlusNews) - New technologies are helping Zambia make the most of its scarce health workers and laboratories in the fight against tuberculosis (TB), and showing that there may be more to a container than meets the eye.

The Zambia Aids-Related TB Project (ZAMBART), a local NGO that provides testing and treatment, has introduced easy-to-use digital chest x-rays and relatively cheap made-to-order laboratories to help close gaps in stepping up the fight against TB and HIV, which are common co-infections.

In a country where about 39,000 new cases of TB are reported annually, these innovations could help combat the high level of undiagnosed infectious TB, the recent Zambia-South Africa TB and AIDS Reduction
(ZAMSTAR) study noted.

According to UNAIDS, about 14 percent of Zambians are HIV-positive, which greatly increases their vulnerability to TB. ZAMBART estimates that about 70 percent of TB patients are co-infected with HIV, making them harder to diagnose and more likely to die from TB, the leading killer of HIV-positive people worldwide.

Technology meets task shifting

The ZAMSTAR study also found that while many patients with a chronic cough - a symptom of TB - did not seek medical attention, those who did were often poorly investigated.

After routine screening for TB, clinic staff asked TB suspects for a sputum sample. In HIV/TB co-infected patients these samples were more likely to result in a false positive result, so health workers used chest X-rays to confirm test results.

Gideon Phiri, a ZAMBART research associate based at Kanyama Clinic in the Zambian capital, Lusaka, said the facility served an estimated 14,000 households.

Housed in a small container, Kanyama’s new x-ray machine is easy to secure, and a shortage of health workers has been overcome because the machine is so easy to use that local students like Timothy Manja, now in his a third year of study at the nearby Evelyn Hone College, learnt to operate it in a day and can use the experience towards his practical training requirement.

Shortages of medical personnel, such as x-ray operators and lab technicians, have also prompted ZAMBART and Zambia’s Ministry of Health to pilot the use of high school graduates to collect and analyse sputum samples at Kanyama.

Some people see containers as something less than a real lab - that because it's a container it must be poor quality - but inside it's a beautiful lab

The X-rays Manja takes also form part of a database being used by the machine’s manufacturers, Delft Diagnostic Imaging, to develop a system for TB detection, in which a computer would compare a patient’s chest x-ray to a database of images so as to flag possible TB cases. This would facilitate early detection, and also reduce the heavy caseload of health professionals.

Nurse Foster Chileshe said the onsite machine decreased the time patients had to wait for x-rays, and there were fewer follow-up losses.

Good things come in containers

The new TB lab at the national reference laboratory in Lusaka, housed in a slightly larger container, is making a big difference. Barry Kosloff, of the London School of Hygiene and Tropical Medicine, ZAMSTAR’s mini-lab project manager and designer of the lab, said while the concept was not new, container-based labs had never been this sophisticated.

Labs are internationally graded according to their biosafety level, or the level of precautions taken to isolate dangerous diseases like TB.
Zambia’s first container lab ranks at 3 on a scale of 1 to 4, with 4 being the level used to control highly contagious biological agents such as hemorrhagic diseases.

“In Africa there’s a great need to expand diagnostic services, [but] up until this lab was done, if you ever wanted to get a biosafety level-3 lab, you’d have to spend three times as much money - around half a million dollars,” Kosloff told IRIN/PlusNews. His container-based labs cost about US$130,000.

In some of Africa’s national reference laboratories, staff battle funding constraints, aging infrastructure and technology, and poor infection controls that leave them frustrated and make it dangerous to test TB cultures like those grown in Kosloff’s lab.

TB cultures are particularly important in diagnosing TB in HIV-positive patients, and to determine whether patients have successfully completed treatment. Additional lab capacity would speed up diagnosis and test results, and increase the number of patients referred for treatment.

Container labs are produced, in part, by a South African manufacturer, and can be on the ground about three months after being ordered.

Despite what Kosloff called “container stigma” - because governments seemed to look down on non-permanent structures - countries like Haiti, Peru and Kenya have all expressed interest.

Because each lab is built to order, Kosloff said, it could be adapted to country-specific needs, including water tanks or generators for areas with interrupted water and power supplies.

“Some people see containers as something less than a real lab - that because it’s a container it must be poor quality - but inside it’s a beautiful lab,” he said. “It’s about people getting the best lab for the least amount of money.”

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