Module 1

Overview: Tuberculosis, the

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 Learning Objectives
At the end of this module, the participant will be able to
• Explain the TB epidemic and annual global TB burden
• Describe the forms of TB and how it is transmitted
• Define and compare various methods of TB diagnosis noting
where each is most effective
• Explain the objectives of NTP
• Describe the DOTS component of the STOP TB strategy
• Explain the importance of AFB microscopy in the DOTS program
• Describe functions of laboratories at different levels in TB control
and prevention program

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Content Overview
• What is TB?
• Transmission and Forms of TB
• Risk of Disease
• TB Diagnosis
• Role of the National TB Program
• DOTS component of the STOP TB Strategy
• Building and Enhancing DOTS within the framework of the
STOP TB strategy
• The importance of AFB microscopy in DOTS programs
• Organization of laboratory services

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Global Emergency

Tuberculosis kills 5,000 people a

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 Disturbing Statistics
• 1/3 of world’s population is infected with TB
• 8 Million people develop active TB every year
• More than 100,000 children will die from TB this year
• Hundreds of thousands of children will become TB orphans

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 Country Specific TB Burden
• Ethiopia ranks 8th among 22 high TB burden countries and
one of the top three in Africa
• Incidence ratio of all forms of TB=341/100,000
• Incidence ratio of Smear positive TB=152/100,000
• Prevalence of TB infection =546/100,000
• Mortality rate due to TB=73/100,000
• HIV among TB patients =41%
• HIV accounted for 32% of estimated TB cases in 2005

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What is TB?
• TB is an infectious disease that affects mainly the lungs
(pulmonary TB or PTB) but can also attack any part of
the body (extra-pulmonary TB or EPTB)

• A person with PTB is infectious to others

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 The Cause of TB

• Mycobacterium tuberculosis

• Mycobacterium bovis

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 Staining Characteristics

• Mycobacteria are called

• Organisms appear red on a

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TB Transmission
(infection)

Person to person
via
Airborne transmission
in
Confined environment

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 Risk Factors for Infection
• Exposure to TB bacilli
• Duration of exposure to a person with PTB
• Intensity of exposure
• Untreated AFB smear positive PTB
cases are the most infectious

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Risk Factors for Disease
• Development of disease depends on individual
susceptibility
• HIV increases the risk of getting TB disease
10% Life time risk of TB in HIV negative
10% Annual risk of TB in HIV positive

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Diagnosis of TB
• Direct demonstration of AFB in sample
• Growth of TB bacilli in culture
• Molecular diagnosis
• Skin Test
• X-Ray

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Advantages of
AFB Smear Microscopy
• Microscopy is a simple convenient test
• Requires minimal infrastructure and
equipment
• Highly accurate, inexpensive and fast
• Accessible to the majority of patients
• Prioritizes infectious cases

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Limitations of Microscopy
• Can not distinguish between dead or live bacteria
• High bacterial load >3000–5000 AFB /mL is required
for detection
• Can not do species identification
• Can not perform DST

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Limitations of Culture
• Greater need for
• infrastructure, qualified staff, equipment, and additional safety
measures
• Increased time: weeks for result
• More sensitive to technical deficiencies
• Expensive

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 National Tuberculosis Control
Program (NTP)
• Objectives
• Reduce mortality, morbidity and disease
transmission and avoid the development of drug
resistance
• In the long term, to eliminate suffering due to TB

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 Goals of the NTP
• Detect at least 70% of the infectious cases
• Cure at least 85% of newly detected cases of smear-
positive TB
• Reduce prevalence of and deaths due to TB
• Has strategic plan for 2007/8-2009/10 (Tuberculosis,
TB/HIV and Leprosy Prevention and Control)

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Case Detection and Treatment Success Rates Under
DOTS(Ethiopia)

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 What is STOP TB Strategy
1. Pursuing quality DOTS expansion and enhancement
2. Addressing TB/HIV and MDR-TB
3. Contributing to health system strengthening
4. Engaging all care providers
5. Empowering patients and communities
6. Enabling and promoting research

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DOTS Component of STOP TB
Strategy
• Political commitment to TB control
• Case detection by quality assured bacteriology
• Regular, uninterrupted supply of high quality anti-TB
drugs
• Standardized treatment with supervision and patient
support
• Standardised recording and reporting

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Benefits of DOTS
• Produces cure rates of up to 95 %

• Prevents new infections

• Prevents the development of MDR-TB

• Cost effective

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Role of Laboratory
• Detection of infectious cases

• Monitoring of treatment progress

• Documentation of cure

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Detection and treatment
of infectious cases
reduces the spread of
Tuberculosis!

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 Pulmonary Positive Patients
• AFB smear-positive patients are usually sick
and seek treatment.
• AFB smear-positive patients are much more
likely to die if untreated.
• Untreated, an AFB smear-positive patient may
infect 10–15 persons/year.

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Laboratory Network
National Referral
Laboratory
Regional
Referral
Laboratories

Peripheral
Laboratories
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 Peripheral Laboratory
• Primary role is service provision
• Health center and hospital laboratories
• Sputum specimen collection
• AFB sputum smear microscopy
• Internal quality control
• Microscope care
• Maintenance of laboratory register
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Regional referral Laboratory
• Regional or large hospital
• Services for TB diagnosis
• Sputum specimen collection
• Sputum smear microscopy
• Culture and identification of MTB
• Support for peripheral laboratories
• Supply of reagents and materials
• Training, supervision, EQA of sputum smear microscopy

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National Referral Laboratory
• Country, provincial or state level
• Services for TB diagnosis
• Culture and identification of MTB
• Drug susceptibility testing of TB
• Molecular diagnosis
• Support for the laboratory network
• Advice on procurement
• Organization and participation in training, supervision, EQA of
sputum smear microscopy
• Other activities
• Participation in operational research
• Drug resistance surveillance
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Laboratory is the key
Component in TB Control
NO LABS

N O DIAGNOSIS

NO TREATMENT

NO DOTS

NO TB CONTROL
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 Summary
• What is TB and how it is transmitted?
• What are the goals of NTP?
• Why is microscopy an effective diagnostic
technique?
• What is DOTS?
• What is the role of the laboratory in TB
control?

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