Pre-Ebola virus disease laboratory system and related challenges in Liberia

Abstract

Prior to the Ebola virus disease outbreak in Liberia, the laboratory system was duplicative, fragmented and minimally coordinated. The National Reference Laboratory was conceptualised to address the existing challenges by promoting the implementation of effective and sustainable laboratory services in Liberia. However, in a resource-limited environment such as Liberia, progress regarding the rebuilding of the health system can be relatively slow, while efforts to sustain the transient gains remain a key challenge for the Ministry of Health. In this paper, we describe the pre-Ebola virus disease laboratory system in Liberia and its prevailing efforts to address future emerging infectious diseases, as well as current Infectious diseases, all of which are exacerbated by poverty. We conclude that laboratory and diagnostic services in Liberia have encountered numerous challenges regarding its efforts to strengthen the healthcare delivery system. These challenges include limited trained human resource capacity, inadequate infrastructure, and a lack of coordination. As with most countries in sub-Saharan Africa, when comparing urban and rural settings, diagnostic and clinical services are generally skewed toward urban health facilities and private, faith-based health facilities. We recommend that structured policy be directed at these challenges for national institutions to develop guidelines to improve, strengthen and sustain diagnostic and curative laboratory services to effectively address current infectious diseases and prepare for future emerging and re-emerging infectious diseases.

Cost analysis of implementing HIV drug resistance testing in Kenya: a case study of a service delivery site at a tertiary level hospital in Kenya

“…Other challenges experienced during the implementation of drug resistance testing included frequent electricity disconnections, which was solved by installing a backup generator to ensure a constant supply of power. This corroborates other previous studies that highlighted similar findings in resource limited settings ( Kennedy et al , 2016 ; Nkengasong et al , 2018 ). Furthermore, supply chain insufficiency, which delayed timely delivery of reagents, consumables, and laboratory equipment, was a major setback in implementing HIVDR testing.…”

“…There are a few laboratory specialists equipped with these skills, making them highly sought after in the job market. This is a challenge in a low resource set up as training personnel on this area is quite expensive ( Abimiku, 2009 ; Kennedy et al , 2016 ; Nkengasong et al , 2018 ; WHO, 2010 ). To counteract this challenge, one of the staff won a training grant to learn HIVDR testing from a laboratory that was already established.…”

“…ART is delivered through the public health approach in most low- and middle-income countries, where standardized drug regimens are administered with simplified laboratory monitoring using tests such as HIV viral load and CD4 count assays ( Lessells et al , 2013 ; De Luca et al , 2013 ; Phillips et al , 2018 ). Access to HIVDR testing is limited for patients in resource-limited settings such as Kenya due to high costs involved and inadequate laboratory capacity ( Kennedy et al , 2016 ; Nkengasong et al , 2018 ; Petti et al , 2006 ). On the other hand, HIVDR testing is offered routinely in resource-rich setting to inform clinical management of people living with HIV ( Dunn et al , 2011 ; Günthard et al , 2019 ).…”

Financing Common Goods for Health: A Country Agenda

“…22 The surveillance systems were weak and fragmented by specific disease programs in a way that impeded their flexibility to adapt to and detect other emerging and infectious diseases that fell outside of their specified mandates. 23 In contrast, the polio surveillance system in Nigeria has developed to serve other notifiable conditions with its strong disease detection, laboratory networks, immunization services, and outbreak preparedness and response structures. 24 In doing so, Nigeria has demonstrated that cross-cutting capabilities in the polio surveillance system could help in other disease outbreaks, while still serving polio-specific needs.…”

Integrated use of the GeneXpert Platform for TB, HIV and EVD Testing in Liberia

“…The laboratory testing service was limited to hospitals, health centers and clinics. There was no specialized and molecular testing capacity at the national reference laboratory which was providing limited testing services for epidemic-prone diseases such as measles, rubella and yellow fever [2,3].…”