Extending Capacity for Pediatric Stool Processing: The Uganda Supranational Reference Laboratory’s (SRL) Program for Multi-Country Training and Capacity Building.
Namutebi Joanita*, Hasfah Nakato, Kabugo Joel, Charles Manyonge, Moorine Ssekade Vincent Kamara, Nyombi Abdnoor and Moses Joloba
ABSTRACT
Background: TB diagnosis in children aged 0-14 years remains a challenge; a majority of pediatric TB cases are clinically diagnosed or are missed altogether. In 2022, WHO recommended stool as an alternative sample method for diagnosing TB in children. However, country uptake of stool sample collection and analysis for TB has been suboptimal. To address this gap, the Uganda Supranational Reference Laboratory (SRL) implemented a capacity strengthening approach consisting of a regional training-of-trainers, virtual community of practice and targeted technical assistance (TA). This work was made possible through the U.S. Agency for International Development under the Tuberculosis Implementation Framework Agreement.
Intervention: In march 2023, SRL developed training materials following an IACET accreditation structure using resources from WHO and KNCV. A Five-day training included theoretical and practical sessions on pediatric TB screening, diagnosis, management, and treatment and comprised 13 modules - available in three languages - PowerPoint presentations, facilitator guides, and exercises. Trainees from 12 countries, including pediatricians and laboratory personnel, completed a pre- and post-test to evaluate knowledge and skills acquired. SRL supplemented the training with a virtual community of practice and targeted TA to facilitate adoption and rollout of stool-based testing for pediatric TB management.
Results/Impact: Twenty-nine (29) personnel were certified as trainer-of-trainers. All participants scored above 80% in the post-test compared to pre-test scores of 34-74%. Twelve country National TB programs developed and endorsed country-specific stool-based testing implementation plans and initiated stool-based testing using the SOS technique. Six community of practice virtual sessions were held, and four countries were selected to receive TA to support country stakeholder engagement meetings, trainings and data management.
Conclusions: Regional-based technical support hubs are critical to extending new and improved diagnostics across countries. Capacity strengthening support including, but not limited to training are needed to support countries to overcome hurdles to rolling-out new diagnostic methods.
