The success of a UMass Medical School laboratory in improving the quality of tuberculosis (TB) testing in some countries hardest hit by the deadly disease is helping to extend this life-saving assistance to other parts of the globe. The Massachusetts Supranational TB Reference Laboratory (MSRL) is now assisting more than 20 countries, mostly in the Caribbean and South America, by providing laboratory assistance and diagnostic services.

Tuberculosis (TB) is one of the most pervasive and deadly diseases in the world, particularly in developing countries that have poor nutrition and a prevalence of HIV/AIDS. According to the World Health Organization (WHO), more than 2 billion people—roughly one-third of the world’s population—harbor the infectious pathogen.

As part of its efforts to deal with this international health issue, the Pan American Health Organization (PAHO) asked MSRL earlier this year to assist several countries with high rates of TB in improving their diagnostic capabilities (see list in sidebar). MSRL’s research is administered by UMass Medical School through a partnership established in 2006 between its Commonwealth Medicine division and the Massachusetts Department of Public Health. The lab has been supporting the need to better diagnose TB worldwide through its involvement with the Supranational TB Reference Laboratory Network, an international collaboration of 29 laboratories established by the WHO in 1996. These labs provide technical assistance and support for establishing quality diagnostics capabilities in countries most burdened by this disease, enabling them to collect reliable data on the incidence and prevalence of drug-resistant TB.

The Massachusetts Supranational TB Reference Laboratory is assisting in the global battle against TB by providing support services in the following countries:

Anguilla
Antigua & Barbuda
Aruba
Bahamas
Barbados
Belize
Bermuda
British Virgin Islands
Cayman Islands
Dominica
Ecuador
French Guyana
Grenada
Guyana
Haiti
Jamaica
Montserrat
Netherlands Antilles
North Korea
Peru
St. Kitts & Nevis
St. Lucia
St. Vincent & the Grenadines
Suriname
Tobago & Trinidad
Turks & Caicos

One of MSRL’s early successes—which set the stage for PAHO’s request—occurred in Peru. Here, the lab focused on the development of laboratory infrastructure and interim laboratory support services for Peru’s national laboratory. Today, that laboratory is performing its own testing and surveillance with external quality support from MSRL, and is a candidate to become a supranational TB reference laboratory itself. “Everything begins with quality. To transfer knowledge and technology successfully, you must implement corresponding quality assurance and quality control measures,” said MSRL Director Alexander Sloutsky, PhD. [link to related story]

The success in Peru led MSRL to assist other countries burdened with TB. In 2008, the lab agreed to provide long-term technical assistance and support for developing diagnostic and surveillance capacity at the National Public Health Laboratory in Haiti, where the estimated incidence and prevalence of TB is among the highest in the Western Hemisphere, and where HIV/AIDS is also widespread. “HIV and TB form a lethal combination, each speeding the other’s progress,” said Commonwealth Medicine Reference Laboratory Director Martin Baker, MS. “This is driving the basic science efforts that Dr. Sloutsky is working on.”

Prior to the devastating earthquake in Haiti on Jan. 12, MSRL had implemented a national external quality assurance project for Acid Fast Bacilli (AFB) smear microscopy, a technique that has diagnosed 70 percent of all TB cases in developing countries. MSRL was planning to manage and provide training for the diagnostic testing, surveillance and quality assurance functions, and eventually transfer management of the operations to the national lab. But after the earthquake, more basic priorities took center stage. “With so much of the public health infrastructure damaged or destroyed, we needed to work with our Haitian partners to reprioritize objectives to ensure that basic diagnostic services are in place,” said Baker. Since then, according to Baker, MSRL’s role has expanded to develop the first drug resistance survey for Haiti’s National Tuberculosis Program as well as implement temporary diagnostic capabilities until a permanent setup can be established.

Currently, MSRL is responding to multiple requests for assistance, including providing broader support to Peru and delivering technical assistance to the Dominican Republic, Ecuador, Jamaica and Suriname. The lab has also expanded efforts in providing diagnostic support services to North Korea through a partnership with the Eugene Bell Foundation, which provides TB care in that country.

About Commonwealth Medicine

Commonwealth Medicine (CWM) is the public, nonprofit health care consulting and service organization founded by UMass Medical School. Government agencies, nonprofits and managed care organizations benefit from CWM’s expertise in clinical service delivery, health care financing strategies, policy management and quality improvement. CWM programs have helped Massachusetts—and many other state, international and local health care agencies—to increase the value of health care expenditures while improving access and delivery of care to at-risk and uninsured populations. CWM programs were developed, in part, as a way for UMMS faculty and staff to have a direct and profound impact on the communities of Massachusetts, and now provide critical opportunities for UMMS faculty and students to serve the community. For more information, visit www.umassmed.edu/commed.