This experience from Uganda indicates that, with collaborative efforts, funding, and technical support from locally available expertise, it is feasible to set-up and optimally operate a BSL-3 TB culture and DST facility with acceptable quality performance in a resource-limited setting.
Damage to a German steel facility occurred during a DST transition in 1993, when a computer timing system linked to a radio time synchronization signal allowed molten steel to cool for one hour less than the required duration, resulting in spattering of molten steel when it was poured.
Mycobacterial culturing and drug susceptibility testing (DST) are not routinely performed due to shortage of facilities and human resources.
The emergence of multidrug resistant (MDR) and extensively drug resistant TB has increased the need to establish more facilities for culture-based drug susceptibility testing (DST), at least until better molecular tests that offer a complete set of DST results needed for patient management become available.
Communication of DST results between central and local laboratories and clinical facilities can be problematic and results can take several months [ 2] to get to their destination or never arrive [ 3], especially in high-burden countries with limited infrastructure.
The authors are grateful to the management of H.K.R.H College, Uthamapalayam, Theni District, DST-FIST and UGC-SAP DRS-II for instrumentation facilities in the Department of Animal Science, Centre of Excellence in Life Sciences, Bharathidasan University, Tiruchirappalli, SAIF-IITM, Chennai for NMR analysis and STIC cochin for DSC analysis.
The DST results were sent back from the NTBRL to the requesting health care facilities; drug-resistant results indicating to the facilities the eligibility of the patients for being referred to SH for specialist treatment.
Patients who were suspected of having DR-TB at any of the health care facilities throughout Gauteng province had their drug susceptibility testing (DST) performed at the South African National TB Reference Laboratory (NTBRL).
BGB thanks Science and Engineering Research Board (SERB), India (ref. EMR/2016/001123), India Srilanka project (DST/INT/SL/P25/2016), UGC-MRPMAJOR-CHEM-2013-35629, UGC-SAP DRS II and DST-FIST New Delhi and Vidyasagar University for financial support and infrastructural facilities.
