International Individual Consultant to Technical Support the South Sudan National Tuberculosis Reference Laboratory (SSNTRL)

Tuberculosis (TB) is one of the top ten global causes of mortality and poses a particular threat to developing countries. It is estimated that one third of the global population carries latent TB, and therefore effective diagnosis and early initiation of patients on treatment are key to reducing the global TB burden.                                                                                                                          Disease transmission and infection will continue if these cases remain undiagnosed and untreated. An infectious TB +ve patient will spread the disease to an average of 10-15 additional people during each year the disease is active.

Conventional TB tests – including sputum smear microscopy, solid or liquid culture – suffer either from low sensitivity, or from high cost and cannot be used at lower health system levels. Modern molecular tools such as GeneXpert machines offer a highly sensitive test for TB and rifampicin resistance with a turn-around time of two hours, offering the ability to test in primary-care facilities. GeneXpert testing has 98% overall sensitivity and can correctly identify up to 70% of the smear negative TB cases. It can also detect rifampicin resistance during the same test cycle, allowing early detection and initiation of patients on MDR TB treatment.

South Sudan National TB Reference Laboratory (SSNTRL), which is mandated to provide technical leadership in Tuberculosis Laboratory network began performing phenotypic testing (solid culture using L J media in 2018 and later introduced Liquid culture using MGIT 960).                                                                                                                                  Among the genotypic testing methods, GeneXpert MTB/ RIF has been on use since 2014 and later 2018 Line probe assay (LPA) was introduced as well.

In the role of Quality assurance, NTRL is supporting TB Lab Network through implementation of Blinded Re-checking EQA component, and capacity building for peripheral labs. With the support from Global Fund, key TB Laboratory guidelines for Quality Assurance, AFB training manuals were developed. However, despite these achievements, the challenges remain immense, including limited trained human resource, limited coverage of TB services, weak network of laboratory services, weak TSRS and the emerging threat of drug resistant TB.

While there is need to have continued roll-out and scale-up of molecular technologies such as use of GeneXpert, there is also the need to plan for the transition of the GeneXpert MTB /RIF to GeneXpert Ultra, and strengthen the TSRS, in addition to develop the capacity of the current NTRL staff. Above all, uptake of TB diagnostic technologies requires appropriate lab infrastructure and properly trained technical staff.