"I remember one young man who was very sick. He had HIV but I couldn't diagnose TB. He was not coughing but he was losing weight fast.We did the TB tests: sputum test and X-ray were negative. The only thing that made me suspect he had TB was his swollen and fluid filled abdomen.I wanted to start TB treatment but the Ministry of Health protocol wouldn't allow it. ..Eventually..he started treatment away from his home in the capital, Lusaka after the Ministry of Health accepted the local doctor's diagnosis there on a clinical basis. The lack of the right diagnostic tools caused a treatment delay of two months" Dr Charles Ssonko, Medical Team Leader for MSF in Zambia
Reality Check: Ensuring the pertinence of TB diagnostic tools for the peripheral level
Symposium at the 39th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease, Paris, Sunday 19th October 2008.
Diagnosing tuberculosis is a very difficult task in the places where MSF works. New developments in the evolution of the disease such as its rapid spread through populations already weakened by HIV infection and the rise of resistant strains of the disease mean that the diagnostic tools available to us are just not up to the task.
There have been advances in improving how we use the tools we have: research into new culture mediums such as liquid culture techniques and Thin Layer Agar or the recently validated molecular techniques to detect drug resistant TB are major steps forward.
But the question remains whether such techniques can fulfill the requirement of bringing TB diagnostics to where they are most needed – to the remotest settlement in the African bush or Peruvian mountain village.
To discuss these issues, MSF organised a symposium at the Union Conference in October 2008 to explore our own and and others’ experience in the implementation of tuberculosis diagnostic tools. It aimed to stimulate further discussion on concrete initiatives including research consortia or funding mechanisms that will boost the development of TB diagnostic tools relevant for resource-poor settings.
Matching medical needs with new funding ideas: In April 2008, MSF brought together experts in fields of TB diagnostics development and health economists to brainstorm new ways of stimulating development of new diagnostic tools for TB.