Does task shifting in tuberculosis microscopy services to non-certified technicians in Afghanistan affect quality?

SETTING: Tuberculosis microscopy centres in 30 provinces in Afghanistan.

OBJECTIVE: To compare the quality of sputum smear examinations in microscopy centres with microscopists who are fully certified as laboratory technicians with those performed in centres with technicians who do not have such certification (high school graduates).

DESIGN: Cross-sectional record review of sputum smear microscopy slides examined by technicians and cross-checked by trained assessors as part of routine external quality assurance between July and September 2009.

RESULTS: Of 129 non-certified technicians, 118 (91%) were stationed in rural health centres compared with 217/257 (84%) certified technicians. From 386 microscopy centres, 7313 slides were cross-checked. Of 257 microscopy centres with certified technicians, 42 (16%) had at least one slide with a major error compared to 23 (18%) of 129 microscopy centres staffed with non-certified technicians. The difference was not statistically significant (OR 1.11, 95%CI 0.64-1.94). The number of slides showing major errors was also similar between the centres with both certified and non-certified technicians.

CONCLUSION: This study confirms the deployment of non-certified microscopy technicians to peripheral health centres throughout the country and that their performance with sputum smear microscopy is similar to that of certified technicians with 3 years of training.