Laboratory is critical component of health systems strengthening:
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1 Building Laboratory Networks in Africa Linda M. Parsons, Ph.D. International ti Laboratory Branch Division of Global AIDS Centers for Disease Control and Prevention Atlanta, GA, USA
2 Presentation Outline Strategies to build sustainable quality laboratory systems and infrastructures in resource-limited settings Increased support and advocacy for strengthening integrated laboratory systems Integrated disease diagnostics (TB/HIV/Malaria/Clinical bio-monitoring) Need for coordinated d support from implementing partners Public / private Clinical trials / surveillance / public health diagnostic systems
3 Global programs on Prevention, Care & Treatment Laboratory is critical component of health systems strengthening: Prevention: Clinical trials Surveillance Clinical diagnosis and staging of disease Blood safety Screening Laboratory Support Outbreak investigation Biosecurity
4 Vision: Strengthen laboratory capacity as part of health systems in PEPFAR-supported countries Build sustainable integrated laboratory capacity Provide quality, rapid, accurate, affordable, diagnostic tests Effective implementation of prevention, surveillance and treatment programs across diseases
5 National TB Laboratory, Bangkok, Thailand
6 15 Countries supported by President s s Emergency Plan for AIDS Relief (PEPFAR) Top 18 of the WHO high-burden countries for TB (greatest numbers of TB cases) 1. Botswana India 2. China Côte d Ivoire 3. Indonesia Ethiopia 4. Nigeria Guyana 5. Bangladesh Haiti 6. Pakistan Kenya 7. South Africa Mozambique 8. Ethiopia Namibia 9. Philippines Nigeria 10. Kenya 11. Rwanda DR Congo 12. Russian Federation South Africa 13. Viet Nam UR Tanzania 14. UR Tanzania Uganda 15. Brazil Viet Nam 16. Uganda Zambia 17. Thailand 18. Mozambique
7 15 PEPFAR countries Botswana Côte d Ivoire Ethiopia Guyana Haiti Kenya Mozambique Namibia Nigeria i Rwanda South Africa UR Tanzania Uganda Viet Nam Zambia WHO 2007 Global TB Report
8 DISEASES OF PUBLIC HEALTH IMPORTANCE Training/Retention Strengthen Laboratory Capacity TIERED LABORATORY SERVICES CROSS-CUTTING STREAMS Linked Referral Services Logistics and Commodities Management Facility & Equipment Maintenance Quality Assurance TB H IV Malaria Immunization INTEGRATED SERVICE DELIVERY
9 Major Challenges in Strengthening Laboratory Systems to Support Global Health HIV/TB/Malaria Programs 1. Human capacity Limited number of trained and skilled personnel Lack of adequate training programs 2. Infrastructure Inadequate supply of electricity and water Physical infrastructure Lack of equipment, supply chain management for consumables and reagents, and maintenance 3. Lack of policies, advocacy, and leadership Lack of laboratory systems No policy No governmental standards for laboratory testing 4. Need for better coordination of partner support
10 JICA World Bank Multi-country AIDS Program (MAP) The Bill and Melinda GATES FOUNDATION EDCTP WELCOME TRUST Clinton Foundation
11 An Era of Increased Resources: An Opportunity or a Challenge? G i b b d Generosity can be a burden: Risk of parallel and/or conflicting lab networks!
12 Strengthen Linkages Between Laboratories via referral systems Regional and District Laboratories National Reference Laboratory
13 Linked Tiered Referral System National Reference Laboratory Regional Reference Laboratories Referral Hospitals Senior Health Scientists Specialists Senior Technologists Program Officers Pi Primary Hospital Health Centers Doctors Nurse Practitioners Medical Assistants Clinical Services in an integrated system
14 TB, HIV, Malaria - Integrated Training Center, Zaria, Nigeria
15 Strengthening Laboratory Infrastructure in Ethiopia i using an Integrated t Approach The Ethiopia National Reference Laboratory: TB, HIV, AI
16 Establishment of the African Centre for Integrated Laboratory Training i 1-3 week trainings in hands-on laboratory techniques Located on campus of NICD in Johannesburg start up mid 2008 Courses based on country needs assessments TB culture and DST DNA PCR for Early Infant Diagnosis of HIV Laboratory Management Commodities Management Biosafety and Laboratory Infrastructure
17 Development and Implementation of a National Laboratory Strategic Plan Goal to establish national quality assured networks of tiered laboratory services Establish a national strategic planning and policy working committee Establish a national laboratory technical working committee to advise MOH
18 Essential Components of a National Laboratory Strategic t Plan Establish minumum standards d for laboratory testing ti Develop human resources Strengthen laboratory capacity Link tiered laboratory services Ensure continuous supply of laboratory commodities Establish program for facility and equipment maintenance Establish roles, responsibilities and accountability Establish targeted health goals that will provide indicators of success
19 Clear indicator/milestones are critical for implementing a Lab Strategic Plan Objective: To develop a comprehensive quality management system in the country 75% of laboratories at all levels l equipped as defined in the strategic plan by the end of 2012? All level 5 laboratories accredited to the ISO by the end of 2012? Quality Assurance and Continuous Quality Improvement Program for laboratory services validated by all laboratories in compliance with the relevant standards for operation by 2012?
20 Development of National Strategic Laboratory Plan in PEPFAR Countries Country Engaged in Discussion Coordinating & Strategic Plan Technical Developed Committees Formed Strategic Plan Implemented Strategic Plan Progress Reviewed & Evaluated Cote d Ivoire Ethiopia Guyana Kenya Lesotho* Mozambique Nigeria Rwanda Swaziland* Tanzania Uganda Vietnam *Non-focus country
21 GAP/CDC In-country Lab Advisors Botswana Ebi Elestin Bile Cambodia Marie Downer Cote d Ivoire Christiane Adje-Toure Ethiopia Peter Fonjungo, Yenuw Kebede, Yohannes Mengistu Guyana Colin Roach Haiti Rachanee Baron Kenya Ernest Makokha, Eileen Burke Mozambique Beth Skaggs Namibia Souleymane Sawadogo Nigeria Kyle Bond Rwanda David McAlister South Africa Jason Williams Tanzania Christine Mwangi Uganda Robert Downing Viet Nam Ritu Shrivastava Zambia Bereneice Madison
22 International Laboratory Branch at Global AIDS Program, CDC Atlanta Katherine Roeder (PHA) Sybil Sobanjo (Procurement) Jhosetta Morrow Nuri Ali Mary Colleton John Nkengasong (FTE) Branch Chief Sherry Orloff (FTE) Lead Public Health Advisor Serology/Incidence Diagnostic Team Molecular Monitoring Team Clinical & OI Monitoring Team Cross-CuttingCutting Team Bharat Parekh (FTE) Team Leader Dennis Ellenberg (FTE) Team Leader Linda Parsons (FTE) Team Leader Tom Spira (FTE) Hetal Patel (FTE) Infant Diagnostics/ Viral Load Unit Drug Resistance Unit Clinical Monitoring Unit OI/TB Unit David Cross (FTE) QA Specialist Xin Liu (FTE) Shambavi Subbarao Unit Lead (FTE) Chunfu Yang Unit Lead (FTE) Larry Westerman Unit Lead (FTE) Akos Somoskovi Unit Lead Katy Yao (FTE) Training Michael Omondi t Richard Respess (FTE) Vedapuri Shanmugam (FTE) Cynthia Warner (FTE) Kyle Tholen t Sheila Abner LIS Nicole Freeman Mirielle Kalou Becky Anderson Artur Ramos (FTE) Al Garcia Silvina Masciotra Karidia Diallo Amanda McNulty Jane Zhou Virginia Cecil Contractor Contractor Zilma Rey Vacant (FTE) Cooperative agreement partners: Ritu Shrivastava ACILT QA Management Unit Debra Kuehl (FTE) Nicole Freeman Oren Mayer Erica Lehotzky (EID Fellow) American Society for Microbiology, Association of Public Health Laboratories
23 Conclusions The opportunity is now to coordinate efforts, build synergies, and develop sustainable lab systems via lab strategic plans with clear indicators Avoid parallel laboratory systems Integrate Public Health Laboratory efforts for Infectious Diseases
24 Thank you
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