Timely and accurate laboratory diagnosis of tuberculosis (TB) plays an important role in its treatment. However, in order to achieve correct results of tests performed in laboratories, it is vital to implement quality assurance and quality control procedures. For such purposes laboratories implement external quality assurance which is special program of the World Health Organization (WHO) for objectively checking the laboratory’s performance using an external higher level laboratory certified by the WHO.
In Turkmenistan the National reference laboratory (NRL) for tuberculosis participates in external quality assurance program with the leading European clinics. In 2010 – 2014, the National institute for Public Health and the Environment (RIMS) in Bilthhoven, Netherlands and from 2014 to present, the Institute of Microbiology and Laboratory Medicine (IML) in Gauting, Germany serve as Supranational reference laboratory (SNRL) for Turkmenistan’s national laboratory.
Annually SNRL sends out strains of TB mycobacteria for re-testing in Turkmenistan’s NRL, and based on results of national laboratory, SNRL presents certificate confirming quality of laboratory tests. Besides, in 2012 and 2018, the National TB program carried out survey on drug resistance in Turkmenistan. In accordance with the survey’s protocol, SNRL would re-check NRL’s results and only after such validation, drug resistance survey results would be considered reliable. In this case NRL ships TB mycobacteria strains to SNRL.
It is important to note that TB mycobacterium is considered as dangerous good and should be transported in strict accordance with the requirements of the International Air Transport Association (IATA).
Main distinction of infectious diseases, including tuberculosis, is their contaminating nature, i.e. risk of transmission of infection from an infected person to a healthy. In case of damage to packaging and leakage during transportation of infectious material, people, animals or any surrounding items may get exposed. This may cause life-threatening or fatal consequences to people. Thus, logistics company providing services on transportation of infectious materials should have proper qualifications as per norms and regulations of IATA.
UNDP project financed by the Global Fund (GF) has been supporting the NRL since 2010. Search for a qualified logistics company resulted in selection of “Bedev Express”, the only company in Turkmenistan which had several qualified specialists with the WHO certificates on infectious material transportation as per IATA regulations and agreed to provide services on shipment of NRL’s dangerous goods.
In process of shipment of TB mycobacteria strains within framework of UNDP project, “Bedev Express” systemized procedures for export of dangerous goods, receipt of permissions from the Ministry of Health and Medical Industry, and the State Customs Service, as well as other required documents. The company worked out such specialized aspects as packaging and proper marking of goods, obligations of transporter and shipper, as well as transportation conditions in various countries.
“Since 2011, we have sent 27 cargoes. The first one was sent via a very complicated route via Abu Dhabi to Amsterdam. Then we have reconsidered the routes and partnered with several companies and airports to ensure that the cargo is delivered on time,” remembers Ata Orazmedov, director of “Bedev Express”.
Partnership with TB project helped the company to gain sufficient experience and knowledge in transportation of dangerous goods. Currently, “Bedev Express” provides logistics services for transportation of other infectious materials, including viruses. The company ships clinical samples and biological materials for the Ministry of Health and Medical Industry of Turkmenistan, the WHO country office in Turkmenistan, as well as number of UN agencies in Turkmenistan.
Standardization of procedure for shipment of dangerous goods with TB mycobacteria strains has significantly simplified process for external quality assurance of laboratory tests, and consequently improved performance of TB laboratories in the country. NRL of Turkmenistan has successfully passes external quality assurance annually since 2010. Good quality operation of TB laboratories in Turkmenistan enables doctors to choose precise medicines, provide quality treatment and effectively fight tuberculosis.