Centre Paul Faure

Tuberculosis (TB) is a huge issue in Djibouti, so my first stop was Centre Paul Faure (CPF), the national reference center for tuberculosis. CPF sees about 9,000 patients per year for diagnosis of TB and many more for follow-up and treatment. The patients are of all ages and come not only from Djibouti but also from neighboring countries such as Ethiopia and Somalia, where diagnostics and treatment are unavailable.
Even though Djibouti is estimated to have the highest prevalence of TB in the world, the laboratory capacity for diagnosis is very limited. Diagnosis is based primarily on smear microscopy, which only detects about half of all positive cases tested, and there is no testing for drug susceptibility that could identify drug resistant strains of TB and allow patients who have resistant strains to have appropriate clinical follow-up.

One of my biggest projects in Djibouti, then, is to improve laboratory capacity for TB diagnosis at CPF. We're going to introduce a new TB diagnostic called MODS (microscopic-observed drug-susceptibility assay) for the diagnosis of all new suspect cases of TB at CPF. The test provides more accurate results (it detects 97% of all positive cases tested!) and also allows drug sensitivity testing for first line TB drugs. Plus the results are available much more rapidly than traditional cultures (most of the time within 5-7 days) and each test costs less than $3.

MODS is a really promising new technology for TB diagnosis, especially in countries like Djibouti. The only issue right now is that we have to turn the following spaces into biosafety level 2 laboratories before we can implement the test. It's going to be a challenge but hopefully we'll be able to do it!