Monitoring and Evaluation of NAAT Labs

Nucleic acid amplification test centres (NAAT centres) including both (Truenat and CBNAAT) are established to diagnose rifampicin resistance among all TB patients (Universal DST). They also serve to diagnose TB among presumptive TB cases from key populations. These labs are established in district TB centres (DTCs), TB units and medical colleges. India is in the process of expanding the NAAT site network. 

• The Central TB Division (CTD) has developed monthly reporting formats both for CBNAAT and Truenat to monitor and evaluate the NAAT labs for measurement of key programme activities on a regular and ongoing basis. This facilitates early identification of any diversions from the planned course of action thereby allowing timely solutions to problems.

• The lab technician (LT) at NAAT labs fills the indicators under the supervision of the senior TB lab supervisor (STLS) and submits the indicators to the concerned Intermediate Reference Laboratories (IRL). 

• The IRL of the state compiles the indicators sent by all the NAAT labs from the districts under them and sends these compiled monthly indicators to their respective National Reference laboratories (NRLs) which in turns compiles and sends the indicators to CTD.

The laboratory indicators for NAAT have to be compiled on a monthly basis which is also updated in Ni-kshay. The online reporting system which has been developed in Ni-kshay eases out the traffic in data flow and shortens the time for submission. Now, the NAAT sites can directly upload and download the monthly indicators.

The indicators are divided to capture general information, workload, referrals from the public sector, referrals from the private sector and stratification of patients. 

A PMDT supervisory checklist is also available for both CBNAAT and Truenat as Annexure 23 in the Guidelines for Programmatic Management of Drug-resistant TB in India 2021 which can be used by the IRLs for their field visits to NAAT sites. 

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NAAT centres are established to identify rifampicin resistance quickly therefore, periodic monitoring and evaluation of these labs are required to optimize the process and the performance. The process streamlining may look at linkage, transportation or logistical issues, and the performance optimization may look at cutting down the time to result and improving the quality of test results.

Resources

• Training Modules (1-4) for Programme Managers & Medical Officers, NTEP, 2020.

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, 2021.

Assessment