Integrated use of laboratory services for multiple infectious diseases in the WHO European Region during the COVID-19 pandemic and beyond

Abstract

Technical advances in diagnostic techniques have permitted the possibility of multi-disease-based approaches for diagnosis and treatment monitoring of several infectious diseases, including tuberculosis (TB), human immunodeficiency virus (HIV), viral hepatitis and sexually transmitted infections (STI). However, in many countries, diagnosis and monitoring, as well as disease response programs, still operate as vertical systems, potentially causing delay in diagnosis and burden to patients and preventing the optimal use of available resources. With countries facing both human and financial resource constraints, during the COVID-19 pandemic even more than before, it is important that available resources are used as efficiently as possible, potential synergies are leveraged to maximise benefit for patients, continued provision of essential health services is ensured. For the infectious diseases, TB, HIV, hepatitis C (HCV) and STI, sharing devices and integrated services starting with rapid, quality-assured, and complete diagnostic services is beneficial for the continued development of adequate, efficient and effective treatment strategies. Here we explore the current and future potential (as well as some concerns), importance, implications and necessary implementation steps for the use of platforms for multi-disease testing for TB, HIV, HCV, STI and potentially other infectious diseases, including emerging pathogens, using the example of the COVID-19 pandemic.

An Integrated Sample Referral System for HIV Viral Load and Early Infant Diagnosis in North-Western Province, Zambia—A Retrospective Cross-Sectional Study

“…The Coronavirus disease 2019 (COVID-19) was first reported in Wuhan City, China in 2019 and spread to countries worldwide, resulting in the World Health Organization (WHO) declaring it a pandemic [ 26 ]. This led to massive disruptions in health systems globally [ 27 ]. The implementation of the integrated courier system was at the height of the COVID-19 pandemic.…”

“…The testing for COVID leveraged the courier in the testing system due to the centralized nature of testing at Solwezi General Hospital. This approach has been reported to be effective in pandemic situations such as with COVID-19 [ 27 ]. This could have helped reduce the TAT for HIV VL and EID as COVID-19 samples were considered urgent as the pandemic unfolded.…”

Missed opportunities for integrated testing of HIV and tuberculosis on the GeneXpert platform in Lesotho

“…This has been observed not just in Africa but also in Europe, because although the WHO European region has moved towards integration, this has had a limited effect on the programmatic organisation for tuberculosis and HIV nationally, which is partly dependent on donor funding that is often project-related and focused on a particular disease. 13 …”

“…The Xpert ® MTB/RIF is a simple and robust test making it feasible for use by people with limited or no laboratory training in peripheral laboratories and clinics. 11 , 12 , 13 In 2016, WHO also approved several point-of-care (POC) assays for HIV diagnostics, including the Xpert HIV-1 Qual for HIV qualitative testing for early infant diagnosis (EID) using whole blood or dried blood spots, which used the same GeneXpert platform. 14 Point-of-care testing provides the opportunity to reduce turnaround times (TAT), limiting patient loss along the HIV testing cascade, reducing infant mortality, and allowing for task shifting to lower cadres of health workers at decentralised facilities.…”

The foundations of aetiology: a common language for infection science

“…In the Principia Aetiologica , this domain was called ‘Consistency’, since the occurrence of more than one case cluster in similar circumstances strengthens the argument for causation, presuming that congruence has already been established. Throughout the COVID-19 pandemic public health laboratories have played a key role in setting and modifying public health controls [9]. In their reference role, public health laboratories conduct investigations that complement individual patient tests, such as molecular epidemiology (genotyping), development and validation of tests for emerging biothreat agents, environmental sample analysis, and reference culture maintenance.…”