1 / 19

Abstract no. WEAD0101

Abstract no. WEAD0101. Decentralization of Laboratory Testing Capacity in Resource-Limited Settings: 7 Years of Experience in six African Countries. F Marinucci , PhD 1 , S Medina-Moreno 1 , AD Paterniti 1 , M Wattleworth 1 ,RR Redfield, MD 1

rafiki
Download Presentation

Abstract no. WEAD0101

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Abstract no. WEAD0101 Decentralization of Laboratory Testing Capacity in Resource-Limited Settings: 7 Years of Experience in six African Countries F Marinucci, PhD 1, S Medina-Moreno 1, AD Paterniti 1, M Wattleworth 1 ,RR Redfield, MD 1 1Institute of Human Virology, University of Maryland School of Medicine, Baltimore, 21201 US

  2. Who We Are? • AIDSRelief Consortium: PEPFAR Track 1.0 IP • Catholic Relief Services (CRS) • University of Maryland School of Medicine – Institute of Human Virology (IHV) • Futures Group (FG) • Catholic Medical Mission Board (CMMB) • IMA World Health (IMA)

  3. Where Do We Work? 44 8 6 18 28 246 Local Partner Treatment Facilities (LPTF)+ 184 satellite sites 22 98 19 3

  4. Who Do We Work With? • 229 sites with laboratory mostly in underserved areas • Urban 58/229 (25%), Peri-urban 20/229 (9%), Rural 151/229 (66%) • A majority of non-public sites and mission facilities • 27% public and 73% non-public. The proportion between public and non-public sites differs by country • Breakdown by level • 17% primary 80% secondary 3% tertiary

  5. Laboratory levels classification based on Maputo Harmonization (2008) www.who.int/entity/diagnostics_laboratory/Maputo-Declaration_2008.pdf

  6. UMSOM-IHV Model of Care Delivery • Cornerstone: decentralization of care and treatment • Care and Tx integrated into existing health care system • Multidisciplinary approach with different areas of intervention • Adherence as a vital therapeutic intervention • Defined catchment area • Highly supported community based adherence follow up • Medically driven CQI • Point-of-care laboratory capacity

  7. Key Advantages Quality is maintained though less complicated means High-throughput, low reagent cost instrumentation is utilized Key Disadvantages Limits for growth Specimen or patient transport Ineffective information systems Key Advantages Patients’ timely access to diagnostics and results No limits for growth Key Disadvantages Complexity of quality systems Higher staff turnover Complexity of instrument service and support Infrastructure Challenges Laboratory Approaches • Centralized System • Point-of-Care System

  8. On-Site Laboratory Capacity • HIV diagnosis: rapid testing • Immunological staging: CD4 absolute/percentage • Safety monitoring: Hct or Hb, ALT, Creat • Major OI diagnosis: AFB, BF malaria, gram staining, CrAg • Monitoring of treatment response/treatment failure

  9. Implementation strategy Three-phase model implemented in collaboration with local partners in Nigeria, Tanzania, Kenya, Uganda, Rwanda, and Zambia site assessment and improvement (Y1-Y3) appropriate technology selection with capacity building through training and laboratory mentoring (Y1-Y5) quality management system strengthening and continuous quality improvement (Y6-Y7)

  10. Phase I • Assessment of site by multidisciplinary teams • Overall laboratory capacity evaluation • Development of site-specific work plan for laboratory strengthening • Laboratory infrastructure refitting

  11. Phase II • Appropriate technology selection and advocacy • national guidelines on equipment/testing algorithm • in-country suppliers able to provide reagents and technical assistance • population size of the catchment area of each site • Capacity building through practical training and laboratory mentoring • Onsite: specific needs, integrated into existing work plans • Centralized: aimed to develop in-country laboratory network • HQ training: comprehensive clinical lab training for field staff

  12. Phase III • Quality management system strengthening • Introduction of new Laboratory Quality Improvement Tools • Improved coordination with MoH, CDC and other stakeholders

  13. Results Number of Local Partner Treatment Facilities with HIV-LTC by Level and Location

  14. Results cont’d Lab workers (N=1152) trained by topic (EA) Increase over time of quality of Malaria and AFB microscopy

  15. Results cont’d Quality of CD4 Testing Capacity (CD4TC) Graded with LQIT by Level and Location

  16. AIDSRelief Patients Over Time

  17. Major achievements • Low overall LTFU rate 4.2% • Viral suppression average across 6 countries 88.7% • Low general mortality rate 8.4% • Decentralization of comprehensive care and treatment

  18. Conclusions • Balancing country-specific and site-specific factors was crucial in adapting this flexible model for decentralizing sustainable HIV-LTC • Integrated and comprehensive approach • Harmonization and standardization • Continuous mentoring of laboratory workers was KEY to support decentralization efforts

  19. Thank you www.ihv.org

More Related