Bankole T. Oluwayomi, Ajayi O. IkeOluwapo
Tuberculosis (TB) (caused by Mycobacterium tuberculosis) and human immunodeficiency virus (HIV) (a Lentivirus) are two interrelated infectious diseases that continue to threaten public health in several parts of the world. In Nigeria, a maximum of 52,000 people died from HIV and TB in 2017. The prevalence of HIV and TB co-infection in Nigeria currently stands around 19.1% which suggests that the two diseases are still a burden on the nation’s health. Improved diagnostic testing at peripheral hospitals is therefore required to facilitate case detection which will reduce the incidence of the two diseases. Thus, this study sought to evaluate the diagnostic microbiology capacity and barriers in testing for HIV and TB at peripheral government-owned secondary hospital- based laboratories in Oyo State, Nigeria. The study used a descriptive cross- sectional design to evaluate 17 government-owned secondary hospital- based laboratories in Oyo State. A WHO laboratory assessment tool was used to evaluate the study laboratories. Diagnostic capacity was measured on a scale of 100- point in which scores ≤ 49% were rated low, fair (50–79%), and good (≥80%). Barriers to diagnosis were summarized in proportions. Criteria used in measuring diagnostic capacity included availability of potent reagent and testing kits, competence of laboratory scientist to perform the test, available standard operating procedure, internal and external quality assessment, availability and functionality of equipment which were scored. A score of 0, 50 and 100 was assigned to no, partial and yes responses respectively and average score was calculated. Evaluation of overall diagnostic capacity showed that 11 (64.7%) and 6 (35.3%) of the laboratories had ‘low’ and ‘fair’ capacity respectively to test sputum or cerebrospinal fluid for TB. For HIV, 14 (82.4%) of the laboratories had ‘low capacity’ and 3 (17.6%) had ‘fair capacity’ to test serum for HIV antigen and blood for viral load. Analysis of type of assay performed at the laboratories indicated that 9 (52.9%) of the laboratories could carry out acid-fast bacilli (AFB) smear using Ziehl-Neelsen stain, 8 (47.1%) Rhodamine/Auramine stain and no laboratory could perform AFB culture and sensitivity. Seven (41.2%) of the laboratories could carry out serological test for HIV and 3 (17.6%) could test blood for viral load. More than 50% of the laboratories reported that unavailable testing kits/reagents for HIV/TB and lack of culture facilities for AFB were the diagnostic barriers responsible for the ‘low’ and ‘fair’ capacity observed in the laboratories. The low capacity of laboratories in this state underscores the need for interventions to improve supply of testing kits, reagents and culture facilities which will enhance prompt detection of HIV and TB cases. It will also improve local healt demands and reduce unnecessary influx of health service seekers to laboratories in tertiary institutions which are already congested.