1. Dr R Ramachandran 5 th Joint International Monitoring Mission to Review NTP Thailand 5th JMM Thailand

2.  Functional quality assured nationwide smear microscopy network (1081)  Current 5 year plan for network of 66 culture labs, 32 FLDST labs is under progress, to be completed 2015  Second Line DST available (MGIT) at NTRL Bangkok (SRL) and Siriraj/Ramathibodi University Hospital (will need to be proficiency tested by NTRL /SRL  Molecular diagnostics LPA (Hain – 12) (YD - 4) RT PCR (GeneXpert -14) (Seegene - 8) 5th JMM Thailand

3.  National policy for sputum collection for diagnosis and follow-up during treatment not uniformly followed  Quality of sputum, staining variable (volume, salivary specimen)  Low smear positivity rate (use of kinyoun cold staining, low sensitivity of conventional light microscopy)  Culture and DST facilities and molecular tools under- used for diagnosis and follow up of TB and DR TB  Laboratory information systems not synchronized with clinical information systems  Many laboratories outside DDC system perform TB diagnostics; not monitored or effectively included in policy dissemination  Laboratories not accredited for TB diagnostic services (culture & DST) 5th JMM Thailand

4.  Address sputum specimen quality, safety ◦ Strictly implement sputum collection policy (especially the 2 nd early morning specimen) ◦ Improve sputum quality by training and education of HCW and patients  To improve smear microscopy sensitivity ◦ Replace Kinyoun cold staining with Ziehl-Neelsen staining ◦ Replace conventional microscopy with LED FM in appropriate settings  Expand access and rational use of newer more sensitive molecular tools to improve case detection of all forms of TB including DR TB  Optimally utilize the culture and DST facilities for management of TB and DR TB 5th JMM Thailand

5.  Link the LMIS to electronic case record system and build capacity for analysis of laboratory indicators to improve performance and throughput  Develop strategies to engage all laboratories with policy and quality standards, beyond DDC network  Enhance quality supervision for EQA (smear) through NTRL/RRL  Ensure that all laboratories providing TB diagnostic services are accredited 5th JMM Thailand

6. Thank You 5th JMM Thailand