RNTCP Annual Report 2012 - TBC India

Case detection through Quality
Assured Bacteriology:
A nationwide network of RNTCP quality assured designated sputum smear microscopy laboratories has been established,
which provides appropriate, affordable and accessible quality assured diagnostic services for TB suspects and
cases. To meet the standards of internationally recommended diagnostic practices for TB, the programme provides the
supply of quality reagents and equipment to the laboratory network. An in-built routine system has been designed for
sputum microscopy External Quality Assessment (EQA) and for supervision and monitoring of the diagnostic systems
by the RNTCP Senior TB Laboratory Supervisor (STLS) locally and by the Intermediate (State level) and National
Reference Laboratory network for RNTCP at higher levels. Introduction of LED Fluorescent Microscopy is being
phased in at high load centres and will be scaled up as per requirements at all levels.
Quality Assured Laboratory services: RNTCP has
established a nationwide laboratory network, encompassing
over 13,000 designated sputum Microscopy
Centres (DMCs), which are being supervised by Intermediate
Reference Laboratories (IRL) at State level, and
National Reference Laboratories (NRL) & Central TB
division at the National level. RNTCP aims to consolidate
the laboratory network into a well-organized one,
with a defined hierarchy for carrying out sputum microscopy
with external quality assessment (EQA), in line
with the new guidance of WHO. RNTCP is gradually
phasing in routine surveillance among the previously
treated cases in states where PMDT has been initiated.
Drug resistance Surveillance (DRS), mycobacterium culture
and Drug susceptibility testing (DST) are undertaken
only among new cases in specific selected settings.
National Reference Laboratories (NRL): The four
NRLs under the programme are Tuberculosis Research
Centre [TRC], Chennai, National Tuberculosis Institute
[NTI], Bangalore, Lala Ram Swarup Institute of Tuberculosis
and Respiratory diseases [LRS], Delhi and JALMA
Institute, Agra. The NRLs work closely with the IRLs,
monitor and supervise the IRL's activities and also undertake
periodic training for the IRL staff in EQA, Cul-
ture & DST activities.
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Three microbiologists and four laboratory technicians
have been provided by the RNTCP on a contractual basis
to each NRL for supervision and monitoring of laboratory
activities. The NRL microbiologist and laboratory
supervisor / technician visits each assigned state at least
once a year for 2 to 3 days as a part of on-site evaluation
under the RNTCP EQA protocol. Regular supervisory
visits are undertaken by the NRL microbiologists to the
IRLs to provide technical support for establishing quality
assured C&DST services, including facility design for
the introduction of newer diagnostic tools (liquid culture
and molecular tests) for the rapid diagnosis of MDR TB
in consultation with other technical agencies like FIND.
NRLs also undertake periodic proficiency testing of the
IRLs as part of the accreditation process under RNTCP.
The National RNTCP Laboratory Committee, constituted
with microbiologists of the NRLs, CTD and WHO
India representatives as members, works as a task force
to guide laboratory related activities of the programme.
This technical body advice the RNTCP on key policy
issues with regard to the laboratory services of the TB
Control Programme.
Table 1: States assigned to NRLs for monitoring of laboratory activities (2011)
NRL
TRC
LRS
States and UnionTerritories (UTs)
assigned for EQA
Andhra Pradesh, Chattisgarh, Goa, Gujarat, Dadra
Nagar Haveli, Daman & Diu, Kerala, Lakshadweep,
Sikkim, Tamil Nadu, Punjab, Chandigarh
Puducherry, Andaman & Nicobar
Delhi, Arunachal Pradesh, Haryana, Manipur,
Nagaland, Mizoram, Meghalaya, Tripura
Total nos. of IRLs
assigned
10
4
Total nos. of states/
UTs assigned
14
8