title: Evidence from 617 laboratories in 47 countries for SLMTA-driven improvement in quality management systems.
abstract: BACKGROUND
  The Strengthening Laboratory Management Toward Accreditation (SLMTA) programme is a large-scale effort to improve the quality of laboratories in resource-limited countries.
  
  
  OBJECTIVE
  This study sought to evaluate the first four years (2010-2013) of SLMTA implementation.
  
  
  METHODS
  Country-level data were submitted by SLMTA programme leads and compiled globally. Performance was measured before (baseline) and after (exit) SLMTA implementation using an audit checklist which results in a percentage score and a rating of zero to five stars. Some laboratories continued to monitor performance in post-exit surveillance audits. We evaluated score improvements using two-tailedt-tests for equal variances and estimated the number of tests performed by SLMTA laboratories based on star level.
  
  
  RESULTS
  SLMTA was implemented in 617 laboratories in 47 countries in Africa, the Caribbean, Latin America and Southeast Asia. At the baseline audit, the laboratories scored an average of 39% on the checklist and 84% of them were rated below one star. As of December 2013, 302 laboratories had completed the SLMTA programme; mean checklist scores increased from 39% at baseline to 64% at exit (p< 0.001) over an average 16-month programme duration. Ninety-two laboratories conducted a surveillance audit at a median of 11 months after their exit audit; 62% further increased their performance. Six SLMTA laboratories have achieved accreditation status. In total, the 617 SLMTA laboratories conduct an estimated 111 million tests annually. Only 16% of these tests were conducted by laboratories with at least one star at baseline, which increased to 68% of tests after SLMTA training. Thus, approximately 23 million tests are conducted annually by laboratories previously at zero stars that now have one to five stars; this number is projected to increase to 58 million when currently-enrolled laboratories complete the programme.
  
  
  CONCLUSIONS
  SLMTA has transformed the laboratory landscape in resource-limited countries worldwide and has the potential to make a substantial and sustainable impact on the quality of laboratory testing and patient care.
authors.affiliation: International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Katy
authors.initials: K
authors.lastname: Yao
authors.affiliation: International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Luman