title: Combatting Global Infectious Diseases: A Network Effect of Specimen Referral Systems.
abstract: The recent Ebola virus outbreak in West Africa clearly demonstrated the critical role of laboratory systems and networks in responding to epidemics. Because of the huge challenges in establishing functional laboratories at all tiers of health systems in developing countries, strengthening specimen referral networks is critical. In this review article, we propose a platform strategy for developing specimen referral networks based on 2 models: centralized and decentralized laboratory specimen referral networks. These models have been shown to be effective in patient management in programs in resource-limited settings. Both models lead to reduced turnaround time and retain flexibility for integrating different specimen types. In Haiti, decentralized specimen referral systems resulted in a 182% increase in patients enrolling in human immunodeficiency virus treatment programs within 6 months. In Uganda, cost savings of up to 62% were observed with a centralized model. A platform strategy will create a network effect that will benefit multiple disease programs.
authors.affiliation: International Laboratory Branch, Division of Global HIV and Tuberculosis (DGHT), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Fonjungo
authors.affiliation: DGHT, CDC, Caribbean Regional Office, Bridgetown, Barbados.
authors.forename: George A
authors.initials: GA
authors.lastname: Alemnji
authors.affiliation: CDC, Addis Ababa, Ethiopia.
authors.forename: Yenew
authors.initials: Y
authors.lastname: Kebede
authors.affiliation: Central Public Health Laboratories, Ministry of Health, and.
authors.forename: Alex
authors.initials: A
authors.lastname: Opio
authors.affiliation: CDC, Kampala, Uganda; and.
authors.forename: Christina
authors.initials: C
authors.lastname: Mwangi
authors.affiliation: HIV Care and Treatment Branch, DGHT, CGH, CDC, Atlanta, Georgia.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Spira
authors.affiliation: International Laboratory Branch, Division of Global HIV and Tuberculosis (DGHT), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: R Suzanne
authors.initials: RS
authors.lastname: Beard
authors.affiliation: International Laboratory Branch, Division of Global HIV and Tuberculosis (DGHT), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: John N
authors.initials: JN
authors.lastname: Nkengasong
keywords: centralized model; decentralized model; innovation.; platform strategy; specimen referral