Waste generated from HIV viral load (VL) testing contains potentially hazardous guanidinium thiocyanate (GTC). GTC is toxic to humans and can pollute waters and harm aquatic life if not disposed of appropriately. We assessed gaps in waste management (WM) policies, regulations and practices through a self-assessment scorecard and an online survey questionnaire among 11 African countries participating in a laboratory systems strengthening community of practice and receiving technical assistance to scale-up VL testing. We identified solutions from national stakeholders, technical agencies, and manufacturers to inform interventions for improving WM. Nine of 11 countries did not have WM policies/guidelines in place. Most Countries reported disposing liquid chemical waste into the sewer. Nine countries prioritised the development of policies as a multi-sectoral approach in the short term. High-temperature incineration through cement factory kilns was identified as an effective, inexpensive and high-capacity disposal option for GTC-containing waste in the short term. A long-term consideration with funding from governments and donors were infrastructural investments for conventional high-temperature incineration where cement factory kilns are unavailable/inaccessible. Adequate WM of GTC-containing waste through available funding could provide the necessary impetus to establish comprehensive WM systems addressing all types of healthcare waste through a multisectoral approach.
The recommended approach for response to severe acute respiratory syndrome coronavirus 2, was to test to enable timely detection, isolation and contact tracing so as to reduce the rapid spread of the disease. This highlighted that the laboratory as one of the core capacities of the International Health Regulations and key technical area in the International Health Security was critical in curbing the spread of the virus. Zimbabwe embarked on testing for SARS-CoV-2 in February 2020 following the guidance and support from WHO leveraging the existing testing capacity. Testing was guided by a laboratory pillar which constituted members from different organizations partnering with the Ministry of Health and Child Care. SARS-CoV-2 testing expansion was based on a phased approach using a tiered system in which laboratory staff from lower tiers were seconded to test for coronavirus using RT-PCR with National Microbiology Reference Laboratory (NMRL) being the hub for centralized consolidation of all results. As the pandemic grew nationally, there was an increase in testing per day and reduction in turnaround time as five laboratories were fully capacitated to test using RT-PCR open platforms, thirty-three provincial and district laboratories to test using TB GeneXpert and 5 provincial laboratories to use Abbott platforms.
Background: New technologies for rapid point-of-care (POC) diagnostic tests hold great potential for improving the health outcomes of HIV-exposed infants. POC testing for HIV early infant diagnosis (EID) was introduced in Lesotho in late 2016. Here we highlight critical requirements for selecting routine POC EID sites to ensure a sustainable and optimised EID diagnostic network.Intervention: Lesotho introduced POC EID in a phased approach that included assessments of national databases to identify sites with high test volumes, the creation of local networks of sites to potentially increase access to POC EID, and a standardised capacity assessment to determine site readiness. Potential site networks comprising ‘hub’ testing sites and ‘spoke’ specimen referring sites were created.Lessons learnt: After determining optimal placement, a total of 29 testing facilities were selected for placement of POC EID to potentially increase access to 189 facilities through the use of a hub-and-spoke model. Site capacity assessments identified vital human resources and infrastructure capacity gaps that needed to be addressed before introducing POC EID and informed appropriate POC platform selection.Recommendations: POC placement involves more than just purchasing the testing platforms. Considering the relatively small proportion of sites that can be eligible for placement of a POC platform, utilising a hub-and-spoke model can maximise the number of health facilities served by a POC platform while reducing the necessary capacity building and infrastructure investments to fewer sites.
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