Annexure 1:Framework for implementing EQA Laboratory network activities under NTEP

There are three levels in EQA Laboratory network under NTEP

1. National Reference Laboratories (NRLs), which are the Central Institutes designated under NTEP. They monitor EQA activities of STDCs/ State labs for the programme. There are six NRLs, viz., National Tuberculosis Institute (NTI) Bengaluru, National Institute for Research in Tuberculosis (NIRT) Chennai, National Institute for Tuberculosis and Respiratory Diseases (NITRD), Bhopal Memorial Hospital and Research Centre (BMHRC) Bhopal, Regional Medical Research Centre (RMRC) Bhubaneshwar and National JALMA Institute for Leprosy and other Mycobacterial Diseases, Agra. Each NRL will eventually monitor 8-12 STDCs/IRLs.
2. STDC Laboratories will work as IRLs in the network. All States should have a State-level reference laboratory for EQA.
3. The Microscopy Centres (MCs)/NAAT sites working for NTEP in the districts will be the Peripheral laboratories.

The three main activities under the NTEP EQA protocol are;

1. On Site Evaluation (OSE): This evaluation is an important activity intended to evaluate whether the programme activities are being carried out i accordance with the recommended guidelines. Guidance is also provided for immediate corrective actions, wherever found necessary. OSE of the STDCs is done at least once a year by NRLs. DTCs (STLS) are evaluated once a year by STDCs and all MCs in the districts at least once a month by respective STLS. Importance will be given for taking action immediately at each level.
2. Panel testing (PT): Panel testing is done mainly to check the staining and smear reading proficiency of LTs of STDCs and STLS of TUs. The Panel testing is not used as a routine for LTs working at TB Diagnostic Centres (TDC). Panel testing of LTs of STDCs and STLS will be conducted once a year under the supervision of the visiting NRL/ STDC team. A set of pre-fixed unstained manufactured slides are used per technician under supervision of the visiting NRL/ STDC supervisor.
3. Blinded Rechecking of slides (RBRC): Blinded rechecking is the most important activity under the EQA programme. It determines the correctness of the smear results of LTs of MCs in an unbiased manner. It is not required for LTs of STDC as STDCs are expected to function at the supervisor level and are not required to perform patient related functions such as diagnosis and follow-up.

Methodology for all the three above mentioned activities is provided in detail in the revised NTEP EQA & DRS Protocols (refer to link)

The EQA for NAAT laboratories are undertaken annually by National Institute.