ReacciónAt the intermediate level (Level II), technologies requiring more sophisticated infrastructure, expertise or biosafety precautions are offered. An important aspect of laboratories at this level is the need for reliable and rapid sample transport networks to transfer samples from peripheral laboratories to the intermediate laboratory, and from the intermediate laboratory to the central laboratory. Combining an efficient specimen referral system with centralized testing can be a cost-effective approach where the burden is low; it can also be more sustainable where there are shortages of skilled staff to capacitate and maintain a large, quality-assured peripheral-level network:
- The new MC-aNAATs are suitable at this level. These tests require laboratory infrastructure that can accommodate instruments that range in size from just under 1 m wide (94 × 75.4 × 72.4 cm) to over 4 m wide (429 × 216 × 129 cm). The throughput of this class of technologies varies, from performing up to 24 samples (multidisease) in one run to 96 samples (single disease) per run. Thus, depending on the specific product and setting, these tests could potentially be positioned at Level II or Level III.
- Culture on liquid or solid media, or FL-LPA or SL-LPA (or both) using sputum specimens may also be applicable at this level, but such tests are gradually being superseded by more automated and rapid alternatives.
- The IGRAs are also suitable for this level of the health system. The test procedure includes multiple steps; also, an ELISA reader or a CLIA analyser that is maintained and calibrated is required to generate results.