Brazzaville – Salomon*, in his 30s, arrives for his session with an envelope containing the outcomes of his laboratory assessments and an x-ray of his lungs, which he fingers to Amélie Makoundou, public well being assistant on the Brazzaville Tuberculosis (TB) Centre. After a radical inspection, Makoundou says: “It’s okay, you’re cured.” Salomon stays emotionless, as if he hasn’t heard what the assistant stated. She repeats: “You’ll be able to cease therapy, you might be cured.” Salomon, who has simply accomplished six months of therapy, thanks Makoundou and leaves with a broad smile.
Prognosis performs a central position within the struggle towards TB, enabling fast detection and therapy. It begins with monitoring continual coughs, and ends with affirmation of TB by way of sputum evaluation within the laboratory. To strengthen its efforts to eradicate TB, the Republic of the Congo, with assist from the World Well being Group (WHO) within the African Area, has restructured its coverage to place laboratory capacity-building on the centre of its technique.
In 2013, Congo acquired its first GeneXpert machine, which allows fast detection of the micro organism answerable for TB. However with restricted capability, the nation continued to ship samples overseas to tradition the mycobacteria and decide resistance to the antibiotics used for therapy. Outcomes took between six and eight months to turn out to be obtainable.
“This case difficult the therapeutic follow-up of sufferers affected by multidrug-resistant tuberculosis, which requires a laboratory able to producing cultures. This considerably delayed the therapy of sufferers with highly-resistant tuberculosis and, on the finish of therapy, the absence of tradition outcomes meant that these sufferers couldn’t even be confirmed as cured,” explains Dr Darrel Ornelle Elion Assiana, Director of the Nationwide Mycobacterial Reference Laboratory (NMRL).
WHO supported the mobilization of sources from the International Fund, and in 2018 the Nationwide Tuberculosis Management Programme (NTCP) acquired a modular microbiological security laboratory for dealing with harmful strains of micro organism. The NMRL now has 46 GeneXpert machines and covers a community of 113 testing and therapy centres throughout the nation’s 12 departments.
Since 2024, due to the assist of WHO and companions such because the United Nations Improvement Programme (UNDP) and the International Fund, Congo has been labeled as a high-burden TB nation with a mycobacteria reference laboratory that meets WHO requirements. The NMRL does extra than simply screening. It provides superior strategies together with microscopy, tradition, anti-TB drug sensitivity assessments and molecular diagnostic assessments, together with genomic surveillance. “Inside two weeks, or a month at most, the outcomes of susceptibility assessments can be found and the affected person can start acceptable therapy,” Assiana says, including that for genotypic susceptibility assessments, the outcomes can be found in between 24 to 48 hours.
Public well being assistant Makoundou sees about 50 sufferers daily. With practically 30 years’ expertise within the area of endemic illnesses, and simply months away from retirement, Makoundou has handled 1000’s of TB sufferers in Congo.
All her work relies on laboratory outcomes. “I’m the one who sends the affected person to the laboratory. We can not put the affected person on therapy with out a lab consequence,” she explains. “On what foundation can we put a affected person on therapy in the event that they don’t bear screening?”
Makoundou’s query underlines the central position of testing within the struggle towards TB, a illness that killed greater than 400 000 individuals within the WHO African Area in 2023, with practically 1.9 million new instances detected and notified in Africa, 14 370 of those in Congo.
WHO and companions are supporting Congo to enhance diagnostic situations by strengthening the nationwide TB reference laboratory. The Group has supported capacity-building for its 5 technicians, and deployed a world laboratory marketing consultant to offer ongoing technical help. “WHO helps the laboratory pillar as it’s important for the fast detection of the illness, permitting clinicians to place sufferers on therapy as rapidly as doable, and assist save lives,” explains Dr Vincent Dossou Sodjinou, Appearing WHO Consultant in Congo. “Our Group is working with nations to finish tuberculosis. Eliminating the illness is a key issue to making sure higher well being for individuals, boosting productiveness and supporting the economic system.”
Thanks to numerous laboratory efforts, 41% of recent TB instances have been detected utilizing fast diagnostic strategies really useful by WHO. The detection of recent instances elevated barely, by nearly 5% between 2022 and 2023, whereas the variety of individuals initiating therapy for drug-resistant TB greater than doubled over the identical interval, from 231 to 494. Early analysis means higher preventive therapy. Greater than 1700 individuals obtained preventive therapy for TB in 2023, a 46% enhance in comparison with 2022.
“It’s due to the laboratory that we will isolate the bacterium answerable for tuberculosis and assess its susceptibility to therapy,” stresses Professor Franck Hardain Okemba-Okombi, Director of the NTCP. “When therapy is initiated, it’s nonetheless the laboratory that allows us to say that there was medical enchancment. It’s all the time the laboratory that can information us on the period of therapy, whether or not the affected person has accomplished his therapy, and whether or not he might be declared cured.”
In 2022, the therapy success price in Congo was 82%, up from 72% in 2019. “It’s an indescribable feeling when a affected person completes therapy and is said cured,” Makoundou says. “Each treatment is a victory and a step ahead within the struggle towards tuberculosis.”
