Laboratory Challenges in the Scaling Up of HIV, TB, and Malaria Programs The Interaction of Health and Laboratory Systems, Clinical Research, and Service Delivery

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
American Journal of Clinical Pathology (Impact Factor: 2.51). 07/2009; 131(6):849-51. DOI: 10.1309/AJCPGH89QDSWFONS
Source: PubMed


Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.

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    • "Over the past decade access to medicines for HIV/AIDS, tuberculosis, and malaria has improved in several countries, but availability and affordability of other essential medicines remains inadequate [89]. Besides insufficient medicine supply chain and procurement systems, many country health systems are burdened by irrational use of available medicines, medical supplies, and laboratory reagents [90]. A great deal of financial support is channelled to the Medicines and Technology building block, but this funding should also address country-specific weaknesses relating to access of essential medicines and technologies when designing a plan of action [91]. "
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    ABSTRACT: Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities -- through conventional 'vertical-programming' approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities. We operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion). According to the analysis, 37% (US$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$ 139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82% of health systems strengthening funding (US$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding. This study shows that a substantial portion of Global Fund's Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions. There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds. Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system.
    Globalization and Health 07/2013; 9(1):30. DOI:10.1186/1744-8603-9-30 · 2.25 Impact Factor
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    • "The concerns regarding the quality of infrastructure have also been highlighted in past studies. For instance, Birx et al. [25] observed that one major challenge to the triad of TB, HIV and malaria control programmes is infrastructural difficulties, in both quality and quantity. Given the high infectivity of TB, it is important to address both quality and quantity of infrastructure concurrently, instead of the present situation where the emphasis seems to be on quantity. "
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    ABSTRACT: Although Ghana does not fall into the category of those countries which have a high burden of tuberculosis (TB), the disease does present considerable economic and health limitations to individuals infected with, and affected by, the disease, as well as to the health system in general. Despite this fact, insufficient studies have been done on the key barriers to controlling the disease. This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers. In-depth interviews were conducted with frontline health workers involved in TB control in the country. Participants were purposively selected from a pool of national and regional, and district and facility level coordinators of the National Tuberculosis Control Programme (NTP). One key informant was also selected from an international non-governmental organisation (NGO) involved in TB-related activities in Ghana. Observations were utilised to complement the study. Data were analysed inductively. Respondents identified the following as being constraints to TB control: clinical complication, bottlenecks in funding administration, quality of physical infrastructure, competition for attention and funding, unsatisfactory coordination between TB and HIV control programmes, a poor public-private partnership, and weak monitoring and evaluation of interventions. This paper provides evidence of some key barriers to TB control. The barriers, as reported, were generally health system-based. Although this list of barriers is not exhaustive, it would be useful to take them into account when planning for TB control, thus adopting a more rounded approach to TB management in the country. As well as that, further studies should be done to explore patients' views on health service-related barriers to TB control.
    Infectious Diseases of Poverty 05/2013; 2(1):9. DOI:10.1186/2049-9957-2-9 · 4.11 Impact Factor
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    • "In response to this, support for health systems in developing countries has become a major focus of many donors, including the Global Fund for AIDS, Tuberculosis and Malaria, the World Bank, the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Health Initiative (GHI), bilateral government support, and private foundations1–3. Though these programmes have helped in increasing the number of people who have access to HIV/AIDS testing and counselling, prevention, care, and treatment services, there are concerns about the inadequacy of sufficient laboratory infrastructure as well as the fragile quality of laboratory services in the majority of the existing laboratories4. This inability of the laboratory infrastructure to fully support the developing country's needs has been the subject of many discussions with the recommendations to review and propose guidelines for setting up more effective laboratory services and systems5. "
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    ABSTRACT: HIV diagnostic and follow up testing are usually done in laboratory settings. However, in developing countries there is a need to decentralize testing as the majority of the population lives in rural settings. In developing countries stringent quality assurance (QA) practices, which include appropriate training, development of standard operating procedures, maintenance of operator proficiency, routine use of quality control (QC) specimens, standardized data management, equipment calibration and maintenance, and biohazard safety with proper disinfection/disposal procedures are not routinely followed to ensure reliability of results and a safe work environment. The introduction of point-of-care testing technologies involving the use of non-laboratorians in routine testing has further increased the complexity of QA. Therefore, a careful approach towards improvement of laboratories that encourages best practices, coupled with incentives, and review of government policies in point-of-care testing is needed to improve quality of testing as decentralization takes place. Development of a functional laboratory tiered network that facilitates communication, referral, training and problem solving could further enhance confidence in laboratory testing. There is also a need for special considerations in implementing a step-wise approach towards quality improvement, strengthening of the supply chain management, human capacity development, infrastructure upgrade, and strong public private partnerships to ensure long term sustainability of these efforts.
    The Indian Journal of Medical Research 12/2011; 134(6):779-86. DOI:10.4103/0971-5916.92625 · 1.40 Impact Factor
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