Submitted by: GS Elmuradova, SR Gamtsemlidze, SU Sayfiddinova, MA Rakhimova – USAID Quality Health Care project; GK Murmusayeva, National Reference Laboratory of the Republic of Uzbekistan; MJ Joncevska, JD lsmoilova, BT Babamuradov, TR Mohr – USAID Quality Health Care project
uzbekistan Expanding external quality assessment for sputum smear microscopy
External quality assessment (EQA) of sputum smear microscopy work in TB laboratories was implemented in Uzbekistan in 2005 in some regions of the country. As most TB laboratory personnel were not yet trained in the EQA technique and regional coordinators did not make regular monitoring visits to regions, most of the regional laboratories did not implement EQA. In addition, no regular feedback between the laboratories at regional and district levels occurred. To improve TB laboratory diagnostics, standardization and unification of TB laboratory diagnostic techniques in Uzbekistan and to enhance the EQA system of smear microscopy, the USAID/ Quality Health Care Project (Quality Project) implemented a combined set of laboratory trainings and follow-up monitoring, which includes EQA based on blinded rechecking. The Quality Project together with the Uzbekistan National Reference Laboratory has developed and adapted an EQA protocol for sputum smear microscopy. To support protocol implementation and eventual countrywide expansion, the Quality Project started conducting training on basic smear microscopy and on the EQA method of smear microscopy for the laboratory specialists of Chilanzar district of Tashkent city, Parkent district of Tashkent region and Samarkand district of Samarkand region. After the training, 36 monitoring visits/on-the-job trainings were conducted jointly with the National Reference Laboratory.
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In 2013, while continuing to support the original pilot sites, the Quality Project supported further expansion of the EQA system to an additional five regions: Ferghana, Bukhara, Surkhandarya, Samarkand and Tashkent. In these regions, regional laboratory coordinators and facility-level laboratory staff were trained. The Quality Project’s support of EQA implementation contributed to increasing the number of laboratories participating in EQA to 129 out of 310 laboratories countrywide. Of participating laboratories, the percentage with good results (smear parameters) increased from 72% (5 out of 7 laboratories participating in EQA) in the first quarter of 2012 to 91% (107 out of 118 laboratories participating in EQA) in the first quarter of 2013. Improving the quality and reliability of laboratory diagnostics not only improves the timely detection of TB patients and obtains qualitative treatment results, but also improves the EQA system and allows laboratory managers to identify weaknesses in the system and to target improvements based on needs identified by data provided by the EQA system. This feedback ensures the long-term efficacy and sustainability of the laboratory network.