Progress in Harmonizing Tiered HIV Laboratory Systems: Challenges and Opportunities in 8 African Countries.
In 2014, the Joint United Nations Programme on HIV/AIDS released its 90-90-90 targets, which make laboratory diagnostics a cornerstone for measuring efforts toward the epidemic control of HIV. A data-driven laboratory harmonization and standardization approach is one way to create efficiencies and ensure optimal laboratory procurements. Following the 2008 "Maputo Declaration on Strengthening of Laboratory Systems"-a call for government leadership in harmonizing tiered laboratory networks and standardizing testing services-several national ministries of health requested that the United States Government and in-country partners help implement the recommendations by facilitating laboratory harmonization and standardization workshops, with a primary focus on improving HIV laboratory service delivery. Between 2007 and 2015, harmonization and standardization workshops were held in 8 African countries. This article reviews progress in the harmonization of laboratory systems in these 8 countries. We examined agreed-upon instrument lists established at the workshops and compared them against instrument data from laboratory quantification exercises over time. We used this measure as an indicator of adherence to national procurement policies. We found high levels of diversity across laboratories' diagnostic instruments, equipment, and services. This diversity contributes to different levels of compliance with expected service delivery standards. We believe the following challenges to be the most important to address: (1) lack of adherence to procurement policies, (2) absence or limited influence of a coordinating body to fully implement harmonization proposals, and (3) misalignment of laboratory policies with minimum packages of care and with national HIV care and treatment guidelines. Overall, the effort to implement the recommendations from the Maputo Declaration has had mixed success and is a work in progress. Program managers should continue efforts to advance the principles outlined in the Maputo Declaration. Quantification exercises are an important method of identifying instrument diversity, and provide an opportunity to measure efforts toward standardization.
Partnership for Supply Chain Management (PFSCM), Supply Chain Management System (SCMS), Arlington, VA, USA. Now with the U.S. Agency for International Development (USAID), Bureau for Global Health, Office of HIV/AIDS, Supply Chain for Health, Washington, DC, USA jwilliams@usaid.gov.
Jason
J
Williams
PFSCM, SCMS, Arlington, VA, USA.
Farouk
F
Umaru
USAID, Bureau for Global Health, Office of HIV/AIDS, Supply Chain for Health, Washington, DC, USA.
Dianna
D
Edgil
USAID, Bureau for Global Health, Office of HIV/AIDS, Supply Chain for Health, Washington, DC, USA.
Joel
J
Kuritsky
D000349:Africa; D004864:Equipment and Supplies; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007391:International Cooperation; D007753:Laboratories / Q000592:standards*; D009313:National Health Programs
Am J Clin Pathol. 2009 Jun;131(6):774
19461081
Am J Clin Pathol. 2009 Jun;131(6):861-6
19461095
Am J Clin Pathol. 2009 Jun;131(6):867-74
19461096
J Acquir Immune Defic Syndr. 2009 Nov;52 Suppl 1:S30-3
19858935
Am J Clin Pathol. 2010 Sep;134(3):374-80
20716792
PLoS One. 2014 Dec 09;9(12):e114727
25490718
Afr J Lab Med. 2014 Sep 05;3(1):101
29043175
Diagnosis (Berl). 2015 Jun 1;2(2):129-135
29540023