Strengthening national health laboratories in sub‐<scp>S</scp>aharan <scp>A</scp>frica: a decade of remarkable progress

Alemnji, George; Zeh, Clement; Yao, Katy; Fonjungo, Peter N.

doi:10.1111/tmi.12269

Cited by 78 publications

(69 citation statements)

References 31 publications

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“…Health systems in many LRS often have limited ability to support large testing networks . In particular, instrument technology‐based testing programs require substantial supportive systems.…”

Section: Improve Testing Efficiencymentioning

confidence: 99%

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Peter¹,

Zeh²,

Katz

et al. 2017

J Intern AIDS Soc

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IntroductionThe scale‐up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point‐of‐care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low‐resource countries. The purpose of this commentary is to review the challenges and solutions from the large‐scale implementation of other diagnostic tests, namely nucleic‐acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale‐up of VL.DiscussionExperience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale‐up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow‐up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business.ConclusionsThe lessons and innovations from large‐scale EID and CD4 programs described here can be adapted to inform more effective scale‐up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost‐effective test access.

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Section: Improve Testing Efficiencymentioning

confidence: 99%

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Peter¹,

Zeh²,

Katz

et al. 2017

J Intern AIDS Soc

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“…SLMTA was introduced in 2009 to provide a systematic, user-friendly approach to achieving laboratory quality improvement and accreditation ( 21 ) and uses a competency-based, step-wise process addressing daily laboratory operations for immediate and measurable laboratory improvement, harmonised to International Organization for Standardization (ISO) 15189 standards ( 8 ). Accreditation is the internationally accepted framework for verifying that laboratories adhere to established quality and competence standards for accurate and reliable patient testing.…”

Section: Introductionmentioning

confidence: 99%

External quality assessment in resource–limited countries

Carter

2017

Biochem Med

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IntroductionHealth laboratory services are a critical component of national health systems but face major operational challenges in resource-limited (RL) settings. New funding for health systems strengthening in RL countries has increased the demand for diagnostics and provided opportunities to address these constraints. An approach to sustainably strengthen national laboratory systems in sub-Saharan African countries is the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. External Quality Assessment (EQA) is a requirement for laboratory accreditation. EQA comprises proficiency testing (PT), rechecking of samples and on-site evaluation.Materials and methodsA systematic literature search was conducted to identify studies addressing laboratory EQA and quality monitoring in RL countries. Unpublished reports were also sought from national laboratory authorities and personnel.ResultsPT schemes in RL countries are provided by commercial companies, institutions in developed countries and national programmes. Most government-supported PT schemes address single diseases using a vertical approach. Regional approaches to delivering PT have also been implemented across RL countries. Rechecking schemes address mainly tuberculosis (TB), malaria and human immunodeficiency virus (HIV); integrated rechecking programmes have been piloted. Constraints include sample transportation, communication of results, unknown proficiency of referee staff and limited resources for corrective action. Global competency assessment standards for malaria microscopists have been established.ConclusionsEQA is vital for monitoring laboratory performance and maintaining quality of laboratory services, and is a valuable tool for identifying and assessing technology in use, identifying gaps in laboratory performance and targeting training needs. Accreditation of PT providers and competency of EQA personnel must be ensured.

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“…These include the World Health Organization Regional Office for Africa, African Society for Laboratory Medicine, and Strengthening Laboratory Management Toward Accreditation programmes. [13] We have had several postgraduate students working on our research projects, some of whom who have already obtained their degrees. Various students also had the opportunity to visit their partner laboratories.…”

Section: Resultsmentioning

confidence: 99%

Biomedical research and capacity building: Bilateral collaboration between research institutes in South Africa and Cameroon

Jacobs

Ikomey

2016

S Afr Med J

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Strengthening national health laboratories in sub‐Saharan Africa: a decade of remarkable progress

Cited by 78 publications

References 31 publications

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

External quality assessment in resource–limited countries

Biomedical research and capacity building: Bilateral collaboration between research institutes in South Africa and Cameroon

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