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Mateta P, Procop GW, Mtotela W, Nyakuwocha R, Fine G. Implementing laboratory quality management in Africa and central Asia: a model for healthcare improvement. Trans R Soc Trop Med Hyg 2022; 116:1077-1081. [PMID: 35793199 DOI: 10.1093/trstmh/trac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/24/2022] [Accepted: 06/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Optimized laboratory services are recognized as an integral part of high-quality healthcare delivery. However, these services are often unavailable or substandard in resource-limited countries. The implementation of quality management systems (QMSs) in the laboratory can transform laboratory services and ultimately improve patient care in these settings. METHODS The Clinical and Laboratory Standards Institute, through its Global Health Partnerships (GHP) program, has intervened in 32 laboratories to implement QMSs and improve performance. Standardized checklists were used before and after the structured intervention to quantify the impact of this program. RESULTS QMS implementation resulted in a statistically significant improvement in overall mean checklist scores. All participating laboratories demonstrated improvement in their quality and performance, with 13 laboratories achieving national accreditation within the time frame of this study. CONCLUSION A structured program that utilizes well-recognized, standardized checklists and has leadership and laboratory team support, professional training with onsite guidance (i.e. train the trainer) and access to professionals experienced with QMS implementation and maintenance can lead to significant improvements in quality in resource-limited countries.
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Affiliation(s)
- Patrick Mateta
- Clinical and Laboratory Standards Institute, Annapolis Junction, 5 Great Valley Parkway, Suite 219, Malvern, PA 19355, USA
| | - Gary W Procop
- American Board of Pathology, 4830 W. Kennedy Blvd., Suite 690, Tampa, FL 33609, USA
| | - Wilson Mtotela
- Clinical and Laboratory Standards Institute, Annapolis Junction, 5 Great Valley Parkway, Suite 219, Malvern, PA 19355, USA
| | - Raymond Nyakuwocha
- Clinical and Laboratory Standards Institute, Annapolis Junction, 5 Great Valley Parkway, Suite 219, Malvern, PA 19355, USA
| | - Glen Fine
- Clinical and Laboratory Standards Institute, Annapolis Junction, 5 Great Valley Parkway, Suite 219, Malvern, PA 19355, USA
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Begg S, Wright A, Small G, Kirby M, Moore S, Koudou B, Kisinza W, Abdoulaye D, Moore J, Malima R, Kija P, Mosha F, Edi C, Bates I. Multi-site comparison of factors influencing progress of African insecticide testing facilities towards an international Quality Management System certification. PLoS One 2021; 16:e0259849. [PMID: 34780512 PMCID: PMC8592480 DOI: 10.1371/journal.pone.0259849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Insecticidal mosquito vector control products are vital components of malaria control programmes. Test facilities are key in assessing the effectiveness of vector control products against local mosquito populations, in environments where they will be used. Data from these test facilities must be of a high quality to be accepted by regulatory authorities, including the WHO Prequalification Team for vector control products. In 2013-4, seven insecticide testing facilities across sub-Saharan Africa, with technical and financial support from Innovative Vector Control Consortium (IVCC), began development and implementation of quality management system compliant with the principles of Good Laboratory Practice (GLP) to improve data quality and reliability. METHODS AND PRINCIPLE FINDINGS We conducted semi-structured interviews, emails, and video-call interviews with individuals at five test facilities engaged in the IVCC-supported programme and working towards or having achieved GLP. We used framework analysis to identify and describe factors affeting progress towards GLP. We found that eight factors were instrumental in progress, and that test facilities had varying levels of control over these factors. They had high control over the training programme, project planning, and senior leadership support; medium control over infrastructure development, staff structure, and procurement; and low control over funding the availability and accessibility of relevant expertise. Collaboration with IVCC and other partners was key to overcoming the challenges associated with low and medium control factors. CONCLUSION For partnership and consortia models of research capacity strengthening, test facilities can use their own internal resources to address identified high-control factors. Project plans should allow additional time for interaction with external agencies to address medium-control factors, and partners with access to expertise and funding should concentrate their efforts on supporting institutions to address low-control factors. In practice, this includes planning for financial sustainability at the outset, and acting to strengthen national and regional training capacity.
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Affiliation(s)
- Sara Begg
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Alex Wright
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, United Kingdom
| | - Graham Small
- Innovative Vector Control Consortium, Pembroke Place, Liverpool, United Kingdom
| | - Matt Kirby
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, United Kingdom
- KCMUCo-PAMVERC, KCMUCo-PAMVERC Test Facility, Moshi, Tanzania
| | - Sarah Moore
- Ifakara Health Institute, Off Mlabani Passage, Ifakara, Tanzania
| | - Ben Koudou
- Centre Suisse de Recherches Scientifques en Côte D’Ivoire, Route de Dabou, Abidjan, Côte d’Ivoire
| | - William Kisinza
- National Institute of Medical Research, Amani Centre, Amani Medical Research Centre, Muheza, Tanzania
| | - Diabate Abdoulaye
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso, Côte d’Ivoire
| | - Jason Moore
- Ifakara Health Institute, Off Mlabani Passage, Ifakara, Tanzania
| | - Robert Malima
- National Institute of Medical Research, Amani Centre, Amani Medical Research Centre, Muheza, Tanzania
| | - Patrick Kija
- National Institute of Medical Research, Amani Centre, Amani Medical Research Centre, Muheza, Tanzania
| | - Frank Mosha
- KCMUCo-PAMVERC, KCMUCo-PAMVERC Test Facility, Moshi, Tanzania
| | - Constant Edi
- Centre Suisse de Recherches Scientifques en Côte D’Ivoire, Route de Dabou, Abidjan, Côte d’Ivoire
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Begg S, Wright A, Small G, Mosha F, Kirby M, Snetselaar J, Aziz S, Bharmal J, Dacombe R, Bates I. Developing laboratory capacity for Good Laboratory Practice certification: lessons from a Tanzanian insecticide testing facility. Gates Open Res 2020; 4:59. [PMID: 32789289 PMCID: PMC7399503 DOI: 10.12688/gatesopenres.13133.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 01/19/2023] Open
Abstract
Background: With increasing insecticide resistance in malaria-endemic countries there is an urgent need for safe and effective novel vector control products. To improve the capacity of facilities that test insecticides in sub-Saharan Africa, a programme is supporting seven facilities towards Good Laboratory Practice (GLP) certification, the globally recognized standard for quality management system (QMS) for the conduct of non-clinical and environmental studies. The World Health Organization (WHO) GLP Handbook provides guidance on a stepwise approach to implement a GLP compliant QMS. This study assesses auditor GLP checklists and timings outlined in the WHO GLP Handbook in the real-life context of a Tanzanian insecticide-testing facility, evaluating their implementation in this context. Methods and Principle Findings: We conducted document review and semi-structured interviews with staff at all levels of the test facility to explore factors that influenced progress towards GLP certification. We found that while auditor GLP checklists underemphasised computer systems, they were otherwise broadly applicable. Factors that delayed time to completion of GLP certification included the need for extensive infrastructure improvements, the availability of regional expertise related to GLP, the capacity of national and regional external systems and services to meet GLP compliance requirements, and training development required for Standard Operating Procedure implementation. Conclusion: The standards required for full GLP compliance are rigorous, with an expected completion timeline to implementation of 24 months. This study shows that in low and middle-income countries this timeline may be unrealistic due to challenges related to infrastructure development and lack of regional capacity and expertise. We recommend a comprehensive gap analysis when starting a project, including these areas which are beyond those recommended by the WHO GLP Handbook. These challenges can be successfully overcome and the experience in Tanzania provides key lessons for other facilities seeking GLP certification or the development of similar QMS.
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Affiliation(s)
- Sara Begg
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Alexandra Wright
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Graham Small
- Innovative Vector Control Consortium (IVCC), Liverpool, L3 5QA, UK
| | | | - Matthew Kirby
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- KCMUCo-PAMVERC Test Facility, Moshi, 255, Tanzania
| | - Janneke Snetselaar
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- KCMUCo-PAMVERC Test Facility, Moshi, 255, Tanzania
| | - Salum Aziz
- KCMUCo-PAMVERC Test Facility, Moshi, 255, Tanzania
| | - Jameel Bharmal
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Russell Dacombe
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Abstract
HIV diagnostics have played a central role in the remarkable progress in identifying, staging, initiating, and monitoring infected individuals on life-saving antiretroviral therapy. They are also useful in surveillance and outbreak responses, allowing for assessment of disease burden and identification of vulnerable populations and transmission "hot spots," thus enabling planning, appropriate interventions, and allocation of appropriate funding. HIV diagnostics are critical in achieving epidemic control and require a hybrid of conventional laboratory-based diagnostic tests and new technologies, including point-of-care (POC) testing, to expand coverage, increase access, and positively impact patient management. In this review, we provide (i) a historical perspective on the evolution of HIV diagnostics (serologic and molecular) and their interplay with WHO normative guidelines, (ii) a description of the role of conventional and POC testing within the tiered laboratory diagnostic network, (iii) information on the evaluations and selection of appropriate diagnostics, (iv) a description of the quality management systems needed to ensure reliability of testing, and (v) strategies to increase access while reducing the time to return results to patients. Maintaining the central role of HIV diagnostics in programs requires periodic monitoring and optimization with quality assurance in order to inform adjustments or alignment to achieve epidemic control.
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Alemnji G, Chase M, Branch S, Guevara G, Nkengasong J, Albalak R. Improving Laboratory Efficiency in the Caribbean to Attain the World Health Organization HIV Treat All Recommendations. AIDS Res Hum Retroviruses 2018; 34:132-139. [PMID: 28967269 DOI: 10.1089/aid.2017.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Scientific evidence showing the benefits of early initiation of antiretroviral therapy (ART) prompted World Health organization (WHO) to recommend that all persons diagnosed as HIV positive should commence ART irrespective of CD4 count and disease progression. Based on this recommendation, countries should adopt and implement the HIV "Treat All" policy to achieve the UNAIDS 90-90-90 targets and ultimately reach epidemic control. Attaining this goal along the HIV treatment cascade depends on the laboratory to monitor progress and measure impact. The laboratory plays an important role in HIV diagnosis to attain the first 90 and in viral load (VL) and HIV drug resistance testing to reinforce adherence, improve viral suppression, and measure the third 90. Countries in the Caribbean region have endorsed the WHO HIV "Treat all" recommendation; however, they are faced with diminishing financial resources to support laboratory testing, seen as a rate-limiting factor to achieving this goal. To improve laboratory coverage with fewer resources in the Caribbean there is the need to optimize laboratory operations to ensure the implementation of high quality, less expensive evidence-based approaches that will result in more efficient and effective service delivery. Suggested practical and innovative approaches to achieve this include: (1) targeted testing within HIV hotspots; (2) strengthening sample referral systems for VL; (3) better laboratory data collection systems; and (4) use of treatment cascade data for programmatic decision-making. Furthermore, strengthening quality improvement and procurement systems will minimize diagnostic errors and guarantee a continuum of uninterrupted testing which is critical for routine monitoring of patients to meet the stated goal.
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Affiliation(s)
- George Alemnji
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- State Department Office of the Global AIDS Coordinator and Health Diplomacy (S/GAC), Washington, District of Columbia
| | - Martine Chase
- Caribbean Regional Office, Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), US Embassy, Bridgetown, Barbados
| | - Songee Branch
- Ladymeade Reference Unit Laboratory, Ministry of Health, Bridgetown, Barbados
| | - Giselle Guevara
- Caribbean Regional Office, Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), US Embassy, Bridgetown, Barbados
| | - John Nkengasong
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Rachel Albalak
- Caribbean Regional Office, Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), US Embassy, Bridgetown, Barbados
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Abstract
PURPOSE OF REVIEW Viral load measurement is a key indicator that determines patients' response to treatment and risk for disease progression. Efforts are ongoing in different countries to scale-up access to viral load testing to meet the Joint United Nations Programme on HIV and AIDS target of achieving 90% viral suppression among HIV-infected patients receiving antiretroviral therapy. However, the impact of these initiatives may be challenged by increased inefficiencies along the viral load testing spectrum. This will translate to increased costs and ineffectiveness of scale-up approaches. This review describes different parameters that could be addressed across the viral load testing spectrum aimed at improving efficiencies and utilizing test results for patient management. RECENT FINDINGS Though progress is being made in some countries to scale-up viral load, many others still face numerous challenges that may affect scale-up efficiencies: weak demand creation, ineffective supply chain management systems; poor specimen referral systems; inadequate data and quality management systems; and weak laboratory-clinical interface leading to diminished uptake of test results. SUMMARY In scaling up access to viral load testing, there should be a renewed focus to address efficiencies across the entire spectrum, including factors related to access, uptake, and impact of test results.
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Viegas SO, Azam K, Madeira C, Aguiar C, Dolores C, Mandlaze AP, Chongo P, Masamha J, Cirillo DM, Jani IV, Gudo ES. Mozambique's journey toward accreditation of the National Tuberculosis Reference Laboratory. Afr J Lab Med 2017; 6:491. [PMID: 28879162 PMCID: PMC5523919 DOI: 10.4102/ajlm.v6i2.491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 12/15/2016] [Indexed: 11/13/2022] Open
Abstract
Background Internationally-accredited laboratories are recognised for their superior test reliability, operational performance, quality management and competence. In a bid to meet international quality standards, the Mozambique National Institute of Health enrolled the National Tuberculosis Reference Laboratory (NTRL) in a continuous quality improvement process towards ISO 15189 accreditation. Here, we describe the road map taken by the NTRL to achieve international accreditation. Methods The NTRL adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a strategy to implement a quality management system. After SLMTA, the Mozambique National Institute of Health committed to accelerate the NTRL’s process toward accreditation. An action plan was designed to streamline the process. Quality indicators were defined to benchmark progress. Staff were trained to improve performance. Mentorship from an experienced assessor was provided. Fulfilment of accreditation standards was assessed by the Portuguese Accreditation Board. Results Of the eight laboratories participating in SLMTA, the NTRL was the best-performing laboratory, achieving a 53.6% improvement over the SLMTA baseline conducted in February 2011 to the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) assessment in June 2013. During the accreditation assessment in September 2014, 25 minor nonconformities were identified and addressed. In March 2015, the NTRL received Portuguese Accreditation Board recognition of technical competency for fluorescence smear microscopy, and solid and liquid culture. The NTRL is the first laboratory in Mozambique to achieve ISO 15189 accreditation. Conclusions From our experience, accreditation was made possible by institutional commitment, strong laboratory leadership, staff motivation, adequate infrastructure and a comprehensive action plan.
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Affiliation(s)
- Sofia O Viegas
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Khalide Azam
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Carla Madeira
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Carmen Aguiar
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Carolina Dolores
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Ana P Mandlaze
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Patrina Chongo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Jessina Masamha
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Daniela M Cirillo
- IRCCS San Raffaele Scientific Institute, WHO Supranational TB Reference Laboratory, Tuberculosis & Mycobacteria Unit, Milan, Italy
| | - Ilesh V Jani
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Eduardo S Gudo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
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Alemnji G, Edghill L, Guevara G, Wallace-Sankarsingh S, Albalak R, Cognat S, Nkengasong J, Gabastou JM. Development and implementation of the Caribbean Laboratory Quality Management Systems Stepwise Improvement Process (LQMS-SIP) Towards Accreditation. Afr J Lab Med 2017; 6:496. [PMID: 28879149 PMCID: PMC5523911 DOI: 10.4102/ajlm.v6i1.496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/30/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Implementing quality management systems and accrediting laboratories in the Caribbean has been a challenge. OBJECTIVES We report the development of a stepwise process for quality systems improvement in the Caribbean Region. METHODS The Caribbean Laboratory Stakeholders met under a joint Pan American Health Organization/US Centers for Disease Control and Prevention initiative and developed a user-friendly framework called 'Laboratory Quality Management System - Stepwise Improvement Process (LQMS-SIP) Towards Accreditation' to support countries in strengthening laboratory services through a stepwise approach toward fulfilling the ISO 15189: 2012 requirements. RESULTS This approach consists of a three-tiered framework. Tier 1 represents the minimum requirements corresponding to the mandatory criteria for obtaining a licence from the Ministry of Health of the participating country. The next two tiers are quality improvement milestones that are achieved through the implementation of specific quality management system requirements. Laboratories that meet the requirements of the three tiers will be encouraged to apply for accreditation. The Caribbean Regional Organisation for Standards and Quality hosts the LQMS-SIP Secretariat and will work with countries, including the Ministry of Health and stakeholders, including laboratory staff, to coordinate and implement LQMS-SIP activities. The Caribbean Public Health Agency will coordinate and advocate for the LQMS-SIP implementation. CONCLUSION This article presents the Caribbean LQMS-SIP framework and describes how it will be implemented among various countries in the region to achieve quality improvement.
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Affiliation(s)
- George Alemnji
- Centers for Disease Control and Prevention (CDC), Caribbean Regional Office, Bridgetown, Barbados
| | - Lisa Edghill
- Caribbean Public Health Agency (CARPHA), Port of Spain, Trinidad and Tobago
| | - Giselle Guevara
- Centers for Disease Control and Prevention (CDC), Caribbean Regional Office, Bridgetown, Barbados
| | | | - Rachel Albalak
- Centers for Disease Control and Prevention (CDC), Caribbean Regional Office, Bridgetown, Barbados
| | | | - John Nkengasong
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States
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Perrone LA, Voeurng V, Sek S, Song S, Vong N, Tous C, Flandin JF, Confer D, Costa A, Martin R. Implementation research: a mentoring programme to improve laboratory quality in Cambodia. Bull World Health Organ 2016; 94:743-751. [PMID: 27843164 PMCID: PMC5043202 DOI: 10.2471/blt.15.163824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To implement a mentored laboratory quality stepwise implementation (LQSI) programme to strengthen the quality and capacity of Cambodian hospital laboratories. METHODS We recruited four laboratory technicians to be mentors and trained them in mentoring skills, laboratory quality management practices and international standard organization (ISO) 15189 requirements for medical laboratories. Separately, we trained staff from 12 referral hospital laboratories in laboratory quality management systems followed by tri-weekly in-person mentoring on quality management systems implementation using the LQSI tool, which is aligned with the ISO 15189 standard. The tool was adapted from a web-based resource into a software-based spreadsheet checklist, which includes a detailed action plan and can be used to qualitatively monitor each laboratory's progress. The tool - translated into Khmer - included a set of quality improvement activities grouped into four phases for implementation with increasing complexity. Project staff reviewed the laboratories' progress and challenges in weekly conference calls and bi-monthly meetings with focal points of the health ministry, participating laboratories and local partners. We present the achievements in implementation from September 2014 to March 2016. FINDINGS As of March 2016, the 12 laboratories have completed 74-90% of the 104 activities in phase 1, 53-78% of the 178 activities in phase 2, and 18-26% of the 129 activities in phase 3. CONCLUSION Regular on-site mentoring of laboratories using a detailed action plan in the local language allows staff to learn concepts of quality management system and learn on the job without disruption to laboratory service provision.
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Affiliation(s)
- Lucy A Perrone
- International Training and Education Center for Health, Department of Global Health, School of Public Health, University of Washington, 901 Boren Ave, Suite 1100, Seattle, WA 98104, United States of America
| | - Vireak Voeurng
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Sophat Sek
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Sophanna Song
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Nora Vong
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Chansamrach Tous
- International Training and Education Center for Health-Cambodia, Phnom Penh, Cambodia
| | - Jean-Frederic Flandin
- International Training and Education Center for Health, Department of Global Health, School of Public Health, University of Washington, 901 Boren Ave, Suite 1100, Seattle, WA 98104, United States of America
| | - Deborah Confer
- International Training and Education Center for Health, Department of Global Health, School of Public Health, University of Washington, 901 Boren Ave, Suite 1100, Seattle, WA 98104, United States of America
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Izquierdo-Álvarez S. [Accreditation: The road to excellence in clinical laboratory]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2015; 30:e1-e3. [PMID: 26913300 DOI: 10.1016/j.cali.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Mesfin EA, Taye B, Belay G, Ashenafi A. The status of medical laboratory towards of AFRO-WHO accreditation process in government and private health facilities in Addis Ababa, Ethiopia. Pan Afr Med J 2015; 22:136. [PMID: 26889317 PMCID: PMC4742023 DOI: 10.11604/pamj.2015.22.136.7187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/12/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction The World Health Organization Regional Office for Africa (WHO AFRO) introduces a step wise incremental accreditation approach to improving quality of laboratory and it is a new initiative in Ethiopia and activities are performed for implementation of accreditation program. Methods Descriptive cross sectional study was conducted in 30 laboratory facilities including 6 laboratory sections to determine their status towards of accreditation using WHO AFRO accreditation checklist and 213 laboratory professionals were interviewed to assess their knowledge on quality system essentials and accreditation in Addis Ababa Ethiopia. Results Out of 30 laboratory facilities 1 private laboratory scored 156 (62%) points, which is the minimum required point for WHO accreditation and the least score was 32 (12.8%) points from government laboratory. The assessment finding from each section indicate that 2 Clinical chemistry (55.2% & 62.8%), 2 Hematology (55.2% & 62.8%), 2 Serology (55.2% & 62.8%), 2 Microbiology (55.2% & 62.4%), 1 Parasitology (62.8%) & 1 Urinalysis (61.6%) sections scored the minimum required point for WHO accreditation. The average score for government laboratories was 78.2 (31.2%) points, of these 6 laboratories were under accreditation process with 106.2 (42.5%) average score, while the private laboratories had 71.2 (28.5%) average score. Of 213 respondents 197 (92.5%) professionals had a knowledge on quality system essentials whereas 155 (72.8%) respondents on accreditation. Conclusion Although majority of the laboratory professionals had knowledge on quality system and accreditation, laboratories professionals were not able to practice the quality system properly and most of the laboratories had poor status towards the WHO accreditation process. Thus government as well as stakeholders should integrate accreditation program into planning and health policy.
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Affiliation(s)
| | - Bineyam Taye
- Addis Ababa University College of Health Science, School of Medicine Addis Ababa, Ethiopia
| | - Getachew Belay
- Ethiopian Health and Nutrition Research Institutes, Addis Ababa, Ethiopia
| | - Aytenew Ashenafi
- African Society for Laboratory Medicine (ASLM) Addis Ababa, Ethiopia
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Ravaghi H, Abolhassani N. Comparison of laboratories directors' and assessors' opinions on challenges and solutions of standardization in Iran: a qualitative study. Glob J Health Sci 2015; 7:358-66. [PMID: 25946940 PMCID: PMC4802179 DOI: 10.5539/gjhs.v7n4p358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/01/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The quality medical laboratory services play a vital role in healthcare systems. Iran has set national standards based on the international standard ISO15189. These standards came into force in September 2007. Given the important role of both laboratories professional and assessors in the standardization, this study aims to compare and analyze medical laboratory directors' and assessors' opinions about this process, its challenges and relevant solutions. METHODS This qualitative study was conducted on two populations in 2013. The first survey population consisted of 150 assessors. The second group consisted of directors working in medical laboratory settings. From all universities of medical sciences, 258 medical laboratories were randomly selected. Data were gathered using two open-ended questionnaires and analyzed using the thematic analysis. RESULTS Challenges and relevant solutions regarding the standardization and standards, the assessment process and assessor, laboratories, external entities and contextual factors across laboratories directors and assessors were derived and compared. Both groups had a positive attitude towards the standardization process. However, they expressed some concerns regarding the process and accordingly proposed solutions to overcome the challenges. CONCLUSION This study provides insights into the challenges and solutions of the standardization from two professional groups' viewpoint. These two factors are closely related and should be considered when implementing standards since a positive perception of them increases the likelihood of successful standardization. Similarities and divergences regarding challenges and solutions of the standardization, in turn, can provide insights into how this process can be improved and deserve policy makers' attention to continue the progress.
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13
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Affiliation(s)
- John N Nkengasong
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, United States
| | - Deborah Birx
- Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, United States
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Guevara G, Gordon F, Irving Y, Whyms I, Parris K, Beckles S, Maruta T, Ndlovu N, Albalak R, Alemnji G. The impact of SLMTA in improving laboratory quality systems in the Caribbean Region. Afr J Lab Med 2014; 3:199. [PMID: 27066396 PMCID: PMC4826060 DOI: 10.4102/ajlm.v3i2.199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Past efforts to improve laboratory quality systems and to achieve accreditation for better patient care in the Caribbean Region have been slow. Objective To describe the impact of the Strengthening of Laboratory Management Toward Accreditation (SLMTA) training programme and mentorship amongst five clinical laboratories in the Caribbean after 18 months. Method Five national reference laboratories from four countries participated in the SLMTA programme that incorporated classroom teaching and implementation of improvement projects. Mentors were assigned to the laboratories to guide trainees on their improvement projects and to assist in the development of Quality Management Systems (QMS). Audits were conducted at baseline, six months, exit (at 12 months) and post-SLMTA (at 18 months) using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist to measure changes in implementation of the QMS during the period. At the end of each audit, a comprehensive implementation plan was developed in order to address gaps. Results Baseline audit scores ranged from 19% to 52%, corresponding to 0 stars on the SLIPTA five-star scale. After 18 months, one laboratory reached four stars, two reached three stars and two reached two stars. There was a corresponding decrease in nonconformities and development of over 100 management and technical standard operating procedures in each of the five laboratories. Conclusion The tremendous improvement in these five Caribbean laboratories shows that SLMTA coupled with mentorship is an effective, user-friendly, flexible and customisable approach to the implementation of laboratory QMS. It is recommended that other laboratories in the region consider using the SLMTA training programme as they engage in quality systems improvement and preparation for accreditation.
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Affiliation(s)
- Giselle Guevara
- US Centers for Disease Control and Prevention, Caribbean Regional Office, Barbados
| | - Floris Gordon
- African Field Epidemiology Network, Caribbean Office
| | - Yvette Irving
- African Field Epidemiology Network, Caribbean Office
| | | | - Keith Parris
- US Centers for Disease Control and Prevention, Caribbean Regional Office, Barbados
| | | | | | | | - Rachel Albalak
- US Centers for Disease Control and Prevention, Caribbean Regional Office, Barbados
| | - George Alemnji
- US Centers for Disease Control and Prevention, Caribbean Regional Office, Barbados
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Gachuki T, Sewe R, Mwangi J, Turgeon D, Garcia M, Luman ET, Umuro M. Attaining ISO 15189 accreditation through SLMTA: A journey by Kenya's National HIV Reference Laboratory. Afr J Lab Med 2014; 3:216. [PMID: 26753130 PMCID: PMC4703332 DOI: 10.4102/ajlm.v3i2.216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The National HIV Reference Laboratory (NHRL) serves as Kenya’s referral HIV laboratory, offering specialised testing and external quality assessment, as well as operating the national HIV serology proficiency scheme. In 2010, the Kenya Ministry of Health established a goal for NHRL to achieve international accreditation. Objectives This study chronicles the journey that NHRL took in pursuit of accreditation, along with the challenges and lessons learned. Methods NHRL participated in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme from 2010–2011. Improvement projects were undertaken to address gaps in the 12 quality system essentials through development of work plans, team formation, training and mentorship of personnel. Audits were conducted and the scores used to track progress along a five-star grading scale. Standard quality indicators (turn-around time, specimen rejection rates and service interruptions) were measured. Costs of improvement projects and accreditation were estimated based on expenditures. Results NHRL scored 45% (zero stars) at baseline in March 2010 and 95% (five stars) after programme completion in October 2011; in 2013 it became the first public health laboratory in Kenya to attain ISO 15189 accreditation. From 2010–2013, turn-around times decreased by 50% – 95%, specimen rejections decreased by 93% and service interruptions dropped from 15 to zero days. Laboratory expenditures associated with achieving accreditation were approximately US $36 500. Conclusion International accreditation is achievable through SLMTA, even for a laboratory with limited initial quality management systems. Key success factors were dedication to a shared goal, leadership commitment, team formation and effective mentorship. Countries wishing to achieve accreditation must ensure adequate funding and support.
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Affiliation(s)
- Thomas Gachuki
- Kenya Ministry of Health, National HIV Reference Laboratory, Kenya
| | - Risper Sewe
- Kenya Ministry of Health, National HIV Reference Laboratory, Kenya
| | - Jane Mwangi
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - David Turgeon
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary Garcia
- Clinical Pathology Laboratories, Austin, Texas, United States
| | - Elizabeth T Luman
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mamo Umuro
- Kenya Ministry of Health, National HIV Reference Laboratory, Kenya
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Maina RN, Mengo DM, Mohamud AD, Ochieng SM, Milgo SK, Sexton CJ, Moyo S, Luman ET. Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement? Afr J Lab Med 2014; 3:222. [PMID: 29043193 PMCID: PMC5637794 DOI: 10.4102/ajlm.v3i2.222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/12/2014] [Indexed: 11/26/2022] Open
Abstract
Background Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation. Methods Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist. Results All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5–45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs. Conclusion Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories.
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Affiliation(s)
| | | | | | | | | | - Connie J Sexton
- US Centers for Disease Control and Prevention, Atlanta, United States
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Princes Marina Hospital, Botswana
| | - Elizabeth T Luman
- US Centers for Disease Control and Prevention, Atlanta, United States
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Nkrumah B, van der Puije B, Bekoe V, Adukpo R, Kotey NA, Yao K, Fonjungo PN, Luman ET, Duh S, Njukeng PA, Addo NA, Khan FN, Woodfill CJI. Building local human resources to implement SLMTA with limited donor funding: The Ghana experience. Afr J Lab Med 2014; 3. [PMID: 26937417 PMCID: PMC4770820 DOI: 10.4102/ajlm.v3i2.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. OBJECTIVES To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. METHOD Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental training on internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM). RESULTS The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors' salaries, SLMTA training and improvement project support. CONCLUSION Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such models promote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.
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Affiliation(s)
- Bernard Nkrumah
- US Centers for Disease Control and Prevention, US Embassy, Ghana
| | | | - Veronica Bekoe
- National AIDS Control Program, Ghana Health Service, Ghana
| | - Rowland Adukpo
- National Public Health Reference Laboratory, Ghana Health Service, Ghana
| | - Nii A Kotey
- Global Health Systems Solutions, C75/20 Amanfro Street, Abelenkpe, Ghana
| | - Katy Yao
- US Centers for Disease Control and Prevention, Atlanta, United States
| | - Peter N Fonjungo
- US Centers for Disease Control and Prevention, Atlanta, United States
| | - Elizabeth T Luman
- US Centers for Disease Control and Prevention, Atlanta, United States
| | - Samuel Duh
- Global Health Systems Solutions, C75/20 Amanfro Street, Abelenkpe, Ghana
| | | | - Nii A Addo
- National AIDS Control Program, Ghana Health Service, Ghana
| | - Fazle N Khan
- US Centers for Disease Control and Prevention, Cote d'Ivoire
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Alemnji GA, Zeh C, Yao K, Fonjungo PN. Strengthening national health laboratories in sub-Saharan Africa: a decade of remarkable progress. Trop Med Int Health 2014; 19:450-8. [PMID: 24506521 DOI: 10.1111/tmi.12269] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Efforts to combat the HIV/AIDS pandemic have underscored the fragile and neglected nature of some national health laboratories in Africa. In response, national and international partners and various governments have worked collaboratively over the last several years to build sustainable laboratory capacities within the continent. Key accomplishments reflecting this successful partnership include the establishment of the African-based World Health Organization Regional Office for Africa (WHO-AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA); development of the Strengthening Laboratory Management Toward Accreditation (SLMTA) training programme; and launching of a Pan African-based institution, the African Society for Laboratory Medicine (ASLM). These platforms continue to serve as the foundations for national health laboratory infrastructure enhancement, capacity development and overall quality system improvement. Further targeted interventions should encourage countries to aim at integrated tiered referral networks, promote quality system improvement and accreditation, develop laboratory policies and strategic plans, enhance training and laboratory workforce development and a retention strategy, create career paths for laboratory professionals and establish public-private partnerships. Maintaining the gains and ensuring sustainability will require concerted action by all stakeholders with strong leadership and funding from African governments and from the African Union.
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Affiliation(s)
- G A Alemnji
- Division of Global HIV/AIDS, Center for Disease Control and Prevention, Caribbean Regional Office, Bridgetown, Barbados
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Kibet E, Moloo Z, Ojwang PJ, Sayed S, Mbuthia A, Adam RD. Measurement of improvement achieved by participation in international laboratory accreditation in sub-Saharan Africa: the Aga Khan University Hospital Nairobi experience. Am J Clin Pathol 2014; 141:188-95. [PMID: 24436265 DOI: 10.1309/ajcpv8a9mrwhgxef] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES As part of the ISO 15189:2007 accreditation process, the Aga Khan University Hospital Nairobi laboratory became the first internationally accredited hospital laboratory in sub-Saharan Africa outside South Africa in 2011 through the South Africa National Accreditation System. METHODS Seven preanalytic, 10 analytic, eight postanalytic, and five administrative performance parameters were monitored from 2009 to 2012 to measure the impact of the accreditation process. RESULTS Most measures in all four categories showed substantial improvement. The seven preanalytic measures all showed major improvement-between a quarter and a half sigma. Real but less dramatic improvement appeared in analytic and postanalytic measures, but greater than one sigma decrease in analytic "procedure violations" and a three-quarter sigma decrease in excessive turnaround time were noted in these categories. Administrative improvements included dramatic decreases in misdirected and missing reports and complaints. CONCLUSIONS This study demonstrates the correlation of the accreditation process with improvement in quality measures in a low-resource region.
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Jegede FE, Mbah HA, Yakubu TN, Adedokun O, Negedu-Momoh OR, Torpey K. Laboratory Quality Audit in 25 Anti-Retroviral Therapy Facilities in North West of Nigeria. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojcd.2014.44028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Mdodo R, Gust D, Otieno FO, McLellan-Lemal E, Chen RT, LeBaron C, Hardnett F, Turner K, Ndivo R, Zeh C, Samandari T, Mills LA. Investigation of HIV Incidence Rates in a High-Risk, High-Prevalence Kenyan Population: Potential Lessons for Intervention Trials and Programmatic Strategies. J Int Assoc Provid AIDS Care 2013; 15:42-50. [PMID: 24309755 DOI: 10.1177/2325957413511667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Cost-effective HIV prevention programs should target persons at high risk of HIV acquisition. We conducted an observational HIV incidence cohort study in Kisumu, Kenya, where HIV prevalence is triple that of the national rate. We used referral and venue-sampling approaches to enroll HIV-negative persons for a 12-month observational cohort, August 2010 to September 2011, collected data using computer-assisted interviews, and performed HIV testing quarterly. Among 1292 eligible persons, 648 (50%) were excluded for HIV positivity and other reasons. Of the 644 enrollees, 52% were women who were significantly older than men (P<.01). In all, 7 persons seroconverted (incidence rate [IR] per 100 person-years=1.11; 95% confidence interval [CI] 0.45-2.30), 6 were women; 5 (IR=3.14; 95% CI 1.02-7.34) of whom were ≤25 years. Most new infections occurred in young women, an observation consistent with other findings in sub-Saharan Africa that women aged ≤25 years are an important population for HIV intervention trials in Africa.
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Affiliation(s)
- Rennatus Mdodo
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Deborah Gust
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Fredrick O Otieno
- Kenya Medical Research Institute (KEMRI)/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Eleanor McLellan-Lemal
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Robert T Chen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Charles LeBaron
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Felicia Hardnett
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Kyle Turner
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Richard Ndivo
- Kenya Medical Research Institute (KEMRI)/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Clement Zeh
- Centers for Disease Control and Prevention (CDC), HIV Research Branch, Kisumu, Kenya
| | - Taraz Samandari
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Lisa A Mills
- Centers for Disease Control and Prevention (CDC), HIV Research Branch, Kisumu, Kenya
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Hinchcliff R, Greenfield D, Westbrook JI, Pawsey M, Mumford V, Braithwaite J. Stakeholder perspectives on implementing accreditation programs: a qualitative study of enabling factors. BMC Health Serv Res 2013; 13:437. [PMID: 24156525 PMCID: PMC4015646 DOI: 10.1186/1472-6963-13-437] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 10/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accreditation programs are complex, system-wide quality and safety interventions. Despite their international popularity, evidence of their effectiveness is weak and contradictory. This may be due to variable implementation in different contexts. However, there is limited research that informs implementation strategies. We aimed to advance knowledge in this area by identifying factors that enable effective implementation of accreditation programs across different healthcare settings. METHODS We conducted 39 focus groups and eight interviews between 2011 and 2012, involving 258 diverse healthcare stakeholders from every Australian State and Territory. Interviews were semi-structured and focused on the aims, implementation and consequences of three prominent accreditation programs in the aged, primary and acute care sectors. Data were thematically analysed to distil and categorise facilitators of effective implementation. RESULTS Four factors were identified as critical enablers of effective implementation: the accreditation program is collaborative, valid and uses relevant standards; accreditation is favourably received by health professionals; healthcare organisations are capable of embracing accreditation; and accreditation is appropriately aligned with other regulatory initiatives and supported by relevant incentives. CONCLUSIONS Strategic implementation of accreditation programs should target the four factors emerging from this study, which may increase the likelihood of accreditation being implemented successfully.
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Affiliation(s)
- Reece Hinchcliff
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney 2052, Australia.
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Hanna M, Minga A, Fao P, Borand L, Diouf A, Mben JM, Gad RR, Anglaret X, Bazin B, Chene G. Development of a checklist of quality indicators for clinical trials in resource-limited countries: the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) experience. Clin Trials 2013; 10:300-18. [PMID: 23345311 DOI: 10.1177/1740774512470765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since 1994, the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) has funded research sites in resource-limited countries (RLCs). These sites implement research on human immunodeficiency virus (HIV) infection and Hepatitis C. In parallel, international regulations and recommendations for clinical trials have evolved and proliferated. However, little guidance exists on how these should be interpreted and applied within academic trials and in the context of RLCs. After developing a specific Ethical Charter for research in developing countries in 2002, ANRS developed a set of quality indicators (QIs) as a monitoring tool for assessing compliance to international guidelines. PURPOSE We describe here the development process, QIs adopted, and areas for improvement. METHODS In 2008, a group of experts was convened that included a researcher representing each ANRS site (Cote d'Ivoire, Senegal, Cameroun, Burkina Faso, Egypt, and Cambodia). Our structuring interaction development process combined evidence and expert opinion in two nominal group meetings to identify (1) clinical trial processes involved, (2) issues specific to RLCs in terms of Good Clinical Practice (GCP) and the application of ethical recommendations, and (3) checklists of QIs adapted to clinical trials conducted in RLCs. RESULTS The trial process reviewed and proposed for RLCs was mostly similar to the one produced in wealthier countries. The scheme generated by our work group added two further processes: 'drug management' and 'biological investigations'. Specific issues regarding trial management in RLCs were therefore described for eight trial steps (1) protocol conception and seeking authorizations, (2) participant enrollment and follow-up, (3) site monitoring, (4) drug management, (5) biological investigations, (6) record management, (7) data management, and (8) site closeout. A total of 58 indicators were identified with at least one indicator for each trial process. LIMITATIONS Some trial activities require further consideration, that is, in the case of vulnerable participants (children, pregnant women). Proposed indicators are the result of expert consensus and reflect their experience in the HIV field. Relevance to existing trials and extrapolation to other fields must be assessed. CONCLUSIONS This innovative program allowed ANRS sites located in RLCs to share their GCP implementation experiences in order to build a list of relevant indicators for clinical trials. The next step is to collect data from ongoing HIV and hepatitis C trials in these settings and will assess the relevance of these indicators to document current quality of performance among trials in resource-limited settings.
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Affiliation(s)
- Mina Hanna
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux Segalen University, Bordeaux, France.
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Chege W, Pals SL, McLellan-Lemal E, Shinde S, Nyambura M, Otieno FO, Gust DA, Chen RT, Thomas T. Baseline findings of an HIV incidence cohort study to prepare for future HIV prevention clinical trials in Kisumu, Kenya. J Infect Dev Ctries 2012; 6:870-80. [PMID: 23276741 PMCID: PMC6066670 DOI: 10.3855/jidc.2636] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/17/2012] [Indexed: 12/21/2022] Open
Abstract
Introduction In an analysis of baseline findings of an HIV incidence cohort study, an assessment was made of HIV prevalence among persons presenting for enrollment and any differences in demographic characteristics between persons not enrolled compared to those enrolled. We also described and compared HIV risk behaviors in males and females enrolled in the study. Methodology A computer-assisted survey was administered to collect baseline demographic and HIV risk data from 1,277 men and women aged 18–34 years. Testing for HIV and other sexually transmitted infections (STI) was conducted. Out of 1,277 persons prescreened for eligibility, 625 were enrolled. Results HIV prevalence of all persons who completed screening was 14.8% (females: 21.1%; males: 8.1%). The odds of being enrolled in the study were higher for persons 18–24 years compared to those 30–34 years of age [adjusted odds ratio (AOR)=2.18, CI=1.13, 4.21] and males compared to females [AOR=2.07, CI=1.43, 2.99]. Among those enrolled in the study, the most prevalent HIV risk behaviors were unprotected sex (49%), alcohol use (45%), and transactional sex (30%) in the last three months. Compared to females, a significantly greater proportion of males reported using any alcohol or recreational drug in the last three months, a history of oral sex, sex with partner other than a spouse or main partner, ever having a blood transfusion, ever being treated for an STI, and having knowledge of their last HIV test result. Conclusion The Kisumu Field Station successfully recruited individuals with HIV risk characteristics for the HIV incidence cohort study.
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Affiliation(s)
- Wairimu Chege
- Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention, Atlanta, USA.
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Cham F, Maleka M, Masango M, Goetsch E, Belabbes EH, Singh B, Gershy-Damet GM, Puren A. The World Health Organization African region external quality assessment scheme for anti-HIV serology. Afr J Lab Med 2012; 1:39. [PMID: 29062735 PMCID: PMC5644520 DOI: 10.4102/ajlm.v1i1.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/21/2012] [Indexed: 11/01/2022] Open
Abstract
A regional external quality assessment scheme (REQAS) for anti-HIV serology aimed to objectively assess reliability and quality of HIV testing processes in the African region. This involved the distribution of proficiency testing (PT) panels to participating laboratories from 2002 to 2010. During the survey period, this included 16 distributions of PT panels to 49 laboratories in 30 countries, and the overall average score during the nine-year survey period was 98.9%, with a frequency of accurate detection, of anti-HIV-1 and/or anti-HIV-2 antibodies in the PT panels, ranging from 93% to 100%. Problems highlighted included lack of human resources and frequent stock outs of test kits, reagents and consumables for routine HIV testing. The design of the REQAS allowed appraisal of the reliability of anti-HIV serological testing methods utilised by laboratories for clinical assessment of patients and/or surveillance programmes. The REQAS was able to demonstrate that laboratories participating in the REQAS performed well and sustained their participation in the scheme. This bodes well for clinical diagnosis, surveillance and training activities at these reference laboratories.
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Affiliation(s)
- Fatim Cham
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Mahlatse Maleka
- Centre for HIV and STI, National Institute for Communicable Diseases, South Africa
| | - Martin Masango
- Centre for HIV and STI, National Institute for Communicable Diseases, South Africa
| | - Emma Goetsch
- Centre for HIV and STI, National Institute for Communicable Diseases, South Africa
| | - El H Belabbes
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Beverley Singh
- Centre for HIV and STI, National Institute for Communicable Diseases, South Africa
| | - Guy M Gershy-Damet
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Adrian Puren
- Centre for HIV and STI, National Institute for Communicable Diseases, South Africa.,Division of Virology and Communicable Disease, University of the Witwatersrand, South Africa
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Braithwaite J, Shaw CD, Moldovan M, Greenfield D, Hinchcliff R, Mumford V, Kristensen MB, Westbrook J, Nicklin W, Fortune T, Whittaker S. Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: a cross-sectional study. Int J Qual Health Care 2012; 24:568-77. [DOI: 10.1093/intqhc/mzs064] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Hinchcliff R, Greenfield D, Moldovan M, Westbrook JI, Pawsey M, Mumford V, Braithwaite J. Narrative synthesis of health service accreditation literature. BMJ Qual Saf 2012; 21:979-91. [PMID: 23038406 DOI: 10.1136/bmjqs-2012-000852] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To systematically identify and synthesise health service accreditation literature. METHODS A systematic identification and narrative synthesis of health service accreditation literature published prior to 2012 were conducted. The search identified 122 empirical studies that examined either the processes or impacts of accreditation programmes. Study components were recorded, including: dates of publication; research settings; levels of study evidence and quality using established rating frameworks; and key results. A content analysis was conducted to determine the frequency of key themes and subthemes examined in the literature and identify knowledge-gaps requiring research attention. RESULTS The majority of studies (n=67) were published since 2006, occurred in the USA (n=60) and focused on acute care (n=79). Two thematic categories, that is, 'organisational impacts' and 'relationship to quality measures', were addressed 60 or more times in the literature. 'Financial impacts', 'consumer or patient satisfaction' and 'survey and surveyor issues' were each examined fewer than 15 times. The literature is limited in terms of the level of evidence and quality of studies, but highlights potential relationships among accreditation programmes, high quality organisational processes and safe clinical care. CONCLUSIONS Due to the limitations of the literature, it is not prudent to make strong claims about the effectiveness of health service accreditation. Nonetheless, several critical issues and knowledge-gaps were identified that may help stimulate and inform discussion among healthcare stakeholders. Ongoing effort is required to build upon the accreditation evidence-base by using high quality experimental study designs to examine the processes, effectiveness and financial value of accreditation programmes and their critical components in different healthcare domains.
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Affiliation(s)
- Reece Hinchcliff
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
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Njai HF, Gombe B, Khamis T, Birungi J, Ruzagira E, Admassu D, Tarragona-Fiol T, Porter K, Stevens G, Mugisha J, Gilmour J, Kamali A, Kaleebu P. Setting Up a Standardized Peripheral Blood Mononuclear Cells Processing Laboratory to Support Multi-center HIV/AIDS Vaccine and Intervention Trials. Lab Med 2011. [DOI: 10.1309/lm84wweuskt4abxo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Laboratory equipment maintenance: A critical bottleneck for strengthening health systems in sub-Saharan Africa? J Public Health Policy 2011; 33:34-45. [DOI: 10.1057/jphp.2011.57] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nkengasong JN. A shifting paradigm in strengthening laboratory health systems for global health: acting now, acting collectively, but acting differently. Am J Clin Pathol 2010; 134:359-60. [PMID: 20716789 DOI: 10.1309/ajcpy5asuejyq5rk] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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