Need for Specimen Collection and Transportation [SCT]

The National TB Elimination Programme (NTEP) has strengthened sputum collection and transport for laboratory testing by building capacity for decentralised collection.

• The provision for sputum collection and transport is used to establish linkages for giving diagnostic access to patients who cannot reach the health facilities. 
• To increase access and coverage of services, designated sputum collection centres are also established for collecting and transporting sputum to the nearby laboratory.

Presumptive TB patients attending Peripheral Health Institutions (PHIs) other than Designated Microscopic Centres (DMCs) are either referred to the nearest DMC for sputum examination or their sputum specimens are collected and transported to the DMC as per guidelines. 

• The patient is given these options as per their convenience to minimise the possible delay in diagnosis and initiation of treatment or avoid repeated visits by the patient.
• In case the patient is not able to travel to the DMC, then the spot sample is collected at the nearest health facility/ sputum collection centre/ sputum collection booths and transported to the DMC.

The need for sample collection can be categorized broadly into two categories:

1. When samples are sent to the DMC

- Some PHI/ sub-centres/ health and wellness centres function as sample collection centres. 

- Sputum collected from referring health facilities needs to be transported to the nearest DMC.

2. When DMC has to collect and transport samples for testing/ follow-up/ resistance testing to higher laboratories

- If the Nucleic Acid Amplification Testing (NAAT) facility is not available at the health facility, the DMC may also need to collect and send the sample to the nearest linked facility for NAAT testing.

- If NAAT is available at DMC and Mycobacterium tuberculosis (MTB) is detected, the second sample needs to be transported to the Culture and Drug Susceptibility Testing (C&DST) lab. If the NAAT result suggests rifampicin-sensitive, a second sample is sent for First-line Line Probe Assay (FL-LPA) to look for H-mono/ poly resistance.

- Extrapulmonary samples have to be appropriately collected at the PHI/HF and transported for testing to NAAT/ culture facilities.

Resources

• Training Module (1-4) for Program Managers and Medical Officers, NTEP, MoHFW, 2020.  

Assessment