by Ambassador Eric Goosby, M.D., U.S. Global AIDS Coordinator
Strong laboratories and well-trained laboratory specialists are critical to well-functioning health systems, enabling clinicians and health workers to diagnose and treat a range of diseases and conditions. In the global response to HIV, reliable, accurate and efficient laboratories and skilled laboratory professionals are central to reaching people living with HIV as early as possible in their disease progression. This is critical to helping them maintain strong immune systems and stave off opportunistic infections, and to reducing the risk of further transmission.
Over the past nine years, PEPFAR has invested approximately $3 billion to create and strengthen lab networks, lab commodities, and the lab workforce, particularly in southern Africa. Through an emphasis on sustainability and the integration of lab services for major diseases of public health importance, PEPFAR investments have created a lasting infrastructure that positions partner countries to respond to HIV and a range of other health challenges, now and in the future. For example, PEPFAR has:
• As of 2012, assisted 21 partner countries (20 of these in Africa) in their development of National Strategic Laboratory Plans.
• Provided support to implement the World Health Organization’s (WHO)/AFRO’s Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) for over 250 labs in 29 African countries and regions.
• Trained nearly 1,000 laboratory staff on specialized techniques at the PEPFAR-established African Center for Integrated Laboratory Training in Johannesburg
• Built, renovated or supported existing labs, and strengthened specimen referral networks. In Fiscal Year 2012, PEPFAR directly supported more than 5,900 laboratories with the capacity to perform HIV-related clinical laboratory tests.
• Worked with partner governments to create a laboratory platform in Africa, which the Department of Health and Human Services’ Centers for Disease Control and Prevention (HHS/CDC) has leveraged to help detect and respond to 900 global outbreaks since 2006, including Ebola and Marburg Hemorrhagic Fever in Uganda in 2012.
• Expanded the use of Dried Blood Spot (DBS) PCR testing for early infant diagnosis from three to 150 labs in 40 countries, resulting in DBS testing of 1.5 million babies and the identification of 375,000 HIV-positive babies needing treatment. An estimated 5 million babies will be tested with this approach through 2015, saving lives and ensuring the accurate monitoring of programs to prevent mother-to-child transmission of HIV.
• Improved the quality control and quality assurance of HIV rapid testing through implementation of proficiency testing and standardized logbooks to assess the performance of individual tests, two test algorithms, and testers. Quality labs save an estimated $30 million per year per 50 million tests.
• Developed and implemented the use of a cost-effective HIV drug resistance test, which saves an estimated $1.3 billion in treatment costs per year by avoiding the unnecessary switching of patients from first-line to more expensive second-line therapies.
• Provided training on HIV and TB diagnosis and patient management in 43 PEPFAR partner countries.
Moving forward, PEPFAR will continue to rely on strong lab systems for the deployment of new, appropriate technologies – including point of care technologies – to test for viral load, CD4, HIV and TB drug resistance, and early infant diagnosis of HIV, among others. This includes assisting countries in their adoption of technologies with proven impact, such as a new, molecular-based TB test that has dramatically reduced the time to diagnosis and treatment for people living with TB and HIV.
In addition, as PEPFAR continues its transition from an emergency effort, to a sustainable and country-owned response, it will look to African-led professional organizations, such as the African Society for Laboratory Medicine (ASLM), to continue leading efforts to promote the sustainability of lab systems and services.
The investments that PEPFAR and other stakeholders have made to advance professional laboratory medicine and improve access to accurate and efficient lab results in Africa have helped pave the way for the unprecedented scale-up of HIV prevention, care and treatment. By strengthening laboratory infrastructure and staff, these investments have also positioned partner countries to respond to a broad range of health issues beyond HIV.
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