TB-LAMP IN CAMEROONTWO YEARS AFTER – RESULTS AND LESSONS LEARNEDBy
DONKENG DONFACK Valerie Flore (PhD)
Centre Pasteur du Cameroun( Mycobacteriology unit, NRL-TB, NTP)

THE 50TH UNION WORLD CONFERENCE ON LUNG HEALTH 30 OCTOBER 2 NOVEMBER 2019. HYDERABAD, INDIA

CONTEXT Land area: 475,440 sq km
 Population: 24 863 337 inhabitants
 254 DTCs (Diagnostic and TreatmentCenters): 1 DTC/90 000 inhabitants
 Epidémiological regions: 12
 Incidence: 194/100000 inhabitants
Cameroon map

TB DIAGNOSIS BEFORE 2017
Main diagnostic tool for initialdiagnosisofPulmonary
Tuberculosis (TB)

Less sensitivity

Microscope
Need to improve TB
case finding in primary
health careLess notification of TB Cases
49 000 cases estimated per year by WHO,
But, only about 25000 cases are notified

HOW IT CHANGED?
54Challenges

3Issues1

2019: Scaling up of TBLAMP in 21 DTCs

2018: Procurement of TBLAMP
reagents
andmaterials

2018:
ValidationofNational TB Programme
2application

2017: Search for funding
using the results of pilotphase2017: Introduction of TBLAMP in Cameroon with 4
HumaLoop T instruments

Procurement of 21
HumaLoop T and45000 tests

Procurement of TB-LAMP materials
Training of Laboratory techniciansSupervisions of the TB-LAMP sites

2018-2020 NTP funding request
addressed to the Global Fund

About 30% increase in positivity at
the four sites after two months

ISSUES AND CHALLENGES
PROCUREMENT
Issues Absence of all TB-LAMP materials on the GDF catalogue to facilitateprocurement
 Partial procurement of materials which were not used
 About 10 months of negotiation by Human and Eiken to obtain all TBLAMP materials available on the GDF catalogue Additional materials not provided with the kits (scissors, gloves, marker pen,tissue papers)

Challenges
 Get all TB-LAMP materials available on the GDF catalogue

ISSUES AND CHALLENGES
IMPLEMENTATION
Challenges
Issues Late availability of funds for thetraining of laboratory technicians
 Absence of funds from GF for
HumaLoop installation
 Lack of a well defined transportsystemforsputum-smear
negative specimen transfer to TBLAMP site

 Installation of the 21 HumaLoop T
instruments at 21 sites for initial TBdiagnosis
 Organization of DTCs by pools at all
the regions for sputum-smear negative
specimens transfer to TB-LAMP site Organization of a well defined sample
and results transportation system Organization of sensitization meetings
with physiciansIMPLEMENTATION RESULTSTB DIAGNOSIS USING TB-LAMP fromNovember 2018 to September 2019
12000

10064

10000
8000
6000

4539

4000
2000

1215
257
171 14 568 51 578 96

1344 1475 1495 1686
274
250
192
111

616

1644

0Total Samples

Positive Samples

TB-LAMP Positivity Rate

 21 new TB-LAMP sites selectedaccording to their workload Replacement of microscopy test on theselected sites by TB-LAMP test for initialdiagnosis of pulmonary TB
 Organization of Sputum-smear negative
specimens transfer from microscopy sites
to TB-LAMP site Organization of TB mass screening inprisons and villages


25
21,15
20
13,57

15
10

7,52

8,18

8,97

14,28

14,82

16,33

16,618,32

50

So far, 23135 tests already performed
from November 2018 to September 2019with 3505 positive (15.15% positivity
rate)
YaoundediagnosedmoreTB
presumptive patients (10064 with 1644
positive, 16.33% positivity rate )Center Region displayed the highest
positivity rate (21.15%)

IMPLEMENTATION RESULTS
 Organization of Sputum smear-negative specimen transfer from microscopy centers to aTB-LAMP center for further testing (Organization of DTCs by pools)
 Use of biker, taxi and travel agencies for samples and transportation and results

TB-LAMP performed on sputum smear
negative specimens
1000

Douala transferred more sputum smear
negative specimens for TB-LAMP
testing (859 with 96 positive cases)
Yaounde displayed the highest
positivity rate (17.31%)859800600

3874002000 00 00 00 00 00 09581572796670Positivity rate of TB-LAMP
performed on sputum smear
negative specimens

Total sputum smear negative specimens
TB-LAMP Positive sputum smear negative specimens

17,19 17,31

20

As at now, 1498 sputum smear
negativespecimens
have
been
transferred for TB-LAMP testing with
198 positive cases. It displayed
13.21% positivity rate

15

11,17
8,42

10
50000000

IMPLEMENTATION RESULTS
 Tuberculosis active cases finding in prisons Tuberculosis active cases finding in villagesTB diagnosis mass campaign in prisons
1400

TB diagnosis mass campaign in threevillages

1285

1200
300

1000

827

250

800593

600

218

200
150400
200

241

243

47

32

2013100

118
80Center

East

Total cases

LittoralAdamaoua

SouthPositives cases

 3066 TB presumptive patients in prisons
have been diagnosed using TB-LAMP.
 120 were positives (3.9% of positivityrate) and submitted to GeneXpert
MTB/RIF to detect RIF-Resistance.
 03 MDR cases have been detected and put
on second line treatment

5067
6330

NdokayoTongo Gandima
Total cases

Ouami

Positives cases

 526 TB presumptive patients in threevillages of the East region have been
diagnosed using TB-LAMP
 12 were positive (2.3% positivity rate) andsubmitted to GeneXpert MTB/RIF todetect RIF-Resistance No MDR cases have been detected

NB:
 All TB diagnosed patients have been rapidly put on treatment
 TB-LAMP and GeneXpert MTB/RIF have been used together

USEFULNESS OF TB-LAMP TEST DURING TBMASS SCREENING
Tuberculosis active case finding in prisons

Tuberculosis active case finding in villages

Case 1: Nkondengui in Yaoundé
Sputum sample collection time: 03 days
Number of sputum samples: 745
Days used for TB-LAMP analysis: 8(112 samples/day)Number of positive samples analyzed
with GeneXpert: 19
MDR cases detected: 01
Time to release of results: 02 days
Total time required for this activity: 13days

Case 2: Ndokayo village in the East Region
 Sputum sample collection time: 02 days
 Number of sputum samples: 241
 Days used for TB-LAMP analysis: 04(60 samples/day)
 Number of positive samples analyzed
with GeneXpert: 03
 MDR cases detected: 00
 Time to release of results: 01 day
 Total time required for this activity: 7days






Conclusion:
 Reduction of turn around time: Only One week used in Ndokayo
village for TB mass screening

LESSONS LEARNED Installation

 Search for Funding-

Include funds for installation andsupervision in application
Include funds to conduct related
activities-

Install the HumaLoop T instrument in
the week following the training oflaboratory techniciansSupervise TB-LAMP tests performedby the trained laboratory technicians
during installation-

 Training--

Train a maximum of 4technicians in three days on one
HumaLoop T
Prepare theoretical and practicaltraining Procurement-

 Improve TB diagnostic andintensified case finding--

Order all materials through GF
Take into account the lead time-

Develop a well organized system forsputum smear negative specimentransportation to perform TB-LAMP
test
Organize meetings with physicians to
inform them about the availability of
the new technique for TB diagnosis
Include TB-LAMP in TB diagnosis
algorithm

NEW CHALLENGESWe cannot completely replace microscopy with TB-LAMP inCameroon, else the HumaLoop will be underused.
Our challenge now is to: Facilitate access to TB-LAMP test for all TB presumptive cases
through sample transportation
 Organize more TB screening campaigns in order to increase thenumber of screening TB presumptive cases Develop a system of rapidly sending test results through SMS

SUMMARYo 22135 tests already performed from November 2018 to September

2019 with 3505 positive (15.15% positivity rate)o 1498 sputum smear negative specimens have been transferred for TBLAMP testing with 198 positive cases. It displayed 13.21% positivity
rateo HumaLoop T is robust, adequate for peripheral laboratories anduseful during TB diagnosis mass campaigns to respect the turn aroundtimeo HumaLoop T and GeneXpert MTB/RIF were used together for TB
mass screening

Recommendations to other countries
 Use TB-LAMP for initial diagnosis of pulmonary TB
 Organize transfer of Sputum smear negative specimens toTB-LAMP analysis to give at all the patient access tomolecular test.
 During fund search, include a budget line for instrument
installation, supervision and related activities
 During purchase, order all materials through GF and do sowell ahead of time to avoid delays.

ACKNOWLEDGMENT
The Ministry of Health of Cameroon through the National
Tuberculosis Program (NTP)Centre Pasteur du Cameroun
Japanese coorperation
Eiken Chemical company
HUMAN company

THANKS FOR YOUR KIND
ATTENTION