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Ndunda JM, Sitati J, Inziani M, Achieng RL, Achieng J, Kennedy L, Kademba C, Wanjiru A, Nduba V, Ndila C, Mwau M. Accreditation of a molecular HIV diagnostic laboratory following the Strengthening Laboratory Management Towards Accreditation (SLMTA)-Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) approach in Kenya: an implementation science study. Pan Afr Med J 2023; 46:60. [PMID: 38223876 PMCID: PMC10787130 DOI: 10.11604/pamj.2023.46.60.39549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction accreditation is the most effective approach to ensure the quality of services. Laboratory performance can be evaluated using the World Health Organization (WHO)-SLIPTA checklist, which checks a laboratory´s compliance with ISO 15189 on a five-star score scale and improved using the SLMTA approach. Compliance is assessed by an external body and can result in accreditation. In this paper, we describe the steps taken by the Kenya Medical Research Institute (KEMRI) HIV Laboratory, Alupe, a resource-limited public entity, towards accreditation, and discuss the lessons learned. Methods the laboratory adopted a SLMTA-SLIPTA approach that included targeted mentorship, on-site workshops, and training. Mentorship-based interventions were used to establish a robust quality management system. Targeted mentorship, on-site workshops, and training were conducted between September 2015 and July 2016. Audits used the SLIPTA checklist to detect gaps in 12 quality system essentials. Performance indicators including turnaround time, external quality assurance, sample rejection rates, and corrective actions were tracked. An external assessment by the national accreditation body was conducted between September 2016 and November 2016. Results training and mentorship-based interventions were successfully conducted. Quality management systems aligned with ISO 15189 were established. Baseline, midterm, and exit audits yielded scores of 47%, 75%, and 94% respectively. Early infant diagnosis external quality assurance scores were 100% in 2014-2016, while average viral load scores were at 60%, 70% and 90% during the same period. Turnaround time from September 2015 surpassed the 80% target. Accreditation was awarded in March 2017. Conclusion the SLMTA-SLIPTA approach is suitable for quality improvement in resource-limited laboratories.
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Affiliation(s)
- Joy Mwende Ndunda
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | - James Sitati
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | - Mary Inziani
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | | | - Janepher Achieng
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | - Laurie Kennedy
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | - Cynthia Kademba
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | - Agnes Wanjiru
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | - Videlis Nduba
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | - Carolyne Ndila
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
| | - Matilu Mwau
- Kenya Medical Research Institute, Mbagathi Road Off Mbagathi Way, Nairobi, Kenya
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Odhiambo CO, van der Puije B, Maina M, Mekonen T, Diallo S, Datema T, Loembe MM, Kebede Y, Ndlovu N, Ondoa P. Examining 7 years of implementing quality management systems in medical laboratories in sub-Saharan Africa. Trop Med Int Health 2023; 28:126-135. [PMID: 36480459 PMCID: PMC10108081 DOI: 10.1111/tmi.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Achievement of ISO15189 accreditation demonstrates competency of a laboratory to conduct testing. Three programmes were developed to facilitate achievement of accreditation in low- and middle-income countries: Strengthening Laboratory Management Towards Accreditation (SLMTA), Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) and Laboratory Quality Stepwise Implementation (LQSI). OBJECTIVE To determine the level of accreditation and associated barriers and facilitators among medical laboratories in the WHO-AFRO region by 2020. METHODS A desk review of SLIPTA and SLMTA databases was conducted to identify ISO15189-accredited medical laboratories between January 2013 and December 2020. Data on access to the LQSI tool were extracted from the WHO database. Facility and country characteristics were collected for analysis as possible enablers of accreditation. The chi-square test was used to analyse differences with level of significance set at <0.05. RESULTS A total of 668 laboratories achieved accreditation by 2020 representing a 75% increase from the number in 2013. Accredited laboratories were mainly in South Africa (n = 396; 55%) and Kenya (n = 106; 16%), two countries with national accreditation bodies. About 16.9% (n = 113) of the accredited laboratories were registered for the SLIPTA programme and 26.6% (n = 178) for SLMTA. Approximately 58,217 LQSI users were registered by December 2020. Countries with a higher UHC index for access to HIV care and treatment, higher WHO JEE scores for laboratory networks, a larger number of registered LQSI users, with national laboratory policy/strategic plans and PEPFAR-priority countries were more likely to have an accredited laboratory. Of the 475 laboratories engaged in the SLIPTA programme, 154 attained ≥4 SLIPTA stars (ready to apply for accreditation) and 113 achieved ISO 15189 accreditation, with 96 enrolled into the SLMTA programme. Lower-tier laboratories were less likely to achieve accreditation than higher-tier laboratories (7.7% vs. 30%) (p < 0.001). The probability of achieving ISO 15189 accreditation (19%) was highest during the first 24 months after enrolment into the SLIPTA programme. CONCLUSION To sustainably anchor quality improvement initiatives at facility level, national approaches including access to a national accreditation authority, adoption of national quality standards and regulatory frameworks are required.
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Affiliation(s)
| | | | - Michael Maina
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Teferi Mekonen
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Samba Diallo
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Laboratory Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Marguerite M Loembe
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Laboratory Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Yenew Kebede
- Laboratory Division, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Nqobile Ndlovu
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Pascale Ondoa
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Amsterdam Institute for Global Health and Development, Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
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Tanasiichuk I, Karaman O, Natrus L. Key success factors for the implementation of quality management systems in developing countries. Afr J Lab Med 2023; 12:2058. [PMID: 36756216 PMCID: PMC9900284 DOI: 10.4102/ajlm.v12i1.2058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background Despite the tremendous progress made in advancing laboratory medicine in low- and middle-income countries (LMICs), inadequate quality management systems (QMSs) remain a problem and barrier to provision of reliable laboratory services in resource-limited settings. Therefore, it is useful to study the experience of medical laboratories in LMICs that have successfully implemented QMS. Aim This review identified key success factors (KSFs) for medical laboratories in LMICs implementing QMS in accordance with the International Organization for Standardization standard 15189 as a pathway to improving laboratory quality. Methods Applying Preferred Reporting Items for Systematic Reviews procedures, we conducted a targeted search of studies from LMICs published between 2012 and 2022 to identify KSFs. Thirty-two out of 952 references retrieved were considered relevant and included in this review. Grounded theory was used to extract key features of the included studies to derive KSFs. Results Ten KSFs for medical laboratories striving to implement QMS were identified and described. These KSFs were integrated to create a model of success for laboratory QMS implementation. The model consists of three underlying factors, namely preparing for change, resource availability, and effective project management, each comprising three separate KSFs. Institutional commitment was identified as the core of the model and is integral to ensuring the quality of laboratory services. Conclusion Laboratories planning to implement a QMS can benefit from understanding the KSFs demonstrated in this study as this would help them to identify the necessary changes to implement and set realistic expectations about the outcomes of QMS implementation.
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Affiliation(s)
- Iryna Tanasiichuk
- Department of Modern Technologies of Medical Diagnostics and Treatment, Institute of Postgraduate Education, Bogomolets National Medical University, Kyiv, Ukraine
| | - Olha Karaman
- Laboratory of Oncoimmunology and Design of Tumor Vaccines, R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Larysa Natrus
- Department of Modern Technologies of Medical Diagnostics and Treatment, Institute of Postgraduate Education, Bogomolets National Medical University, Kyiv, Ukraine
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Abebaw Y, Kebede A, Eshetu K, Tesfaye E, Tadesse M, Sinshaw W, Amare M, Gamtesa DF, Zerihun B, Getu M, Seid G, Yalew A, Diriba G. Quality assurance practices in tuberculosis diagnostic health facilities in Ethiopia. PLoS One 2022; 17:e0269601. [PMID: 35679308 PMCID: PMC9182608 DOI: 10.1371/journal.pone.0269601] [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: 06/26/2021] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The quality of tuberculosis laboratory services in health facilities is a mandatory component of detecting active pulmonary TB cases and treatment follow-up. However, ensuring the quality of laboratory test results is a concern. This study aimed to assess the quality assurance practices in the tuberculosis diagnostic health facilities of Ethiopia. MATERIALS AND METHODS A cross-sectional study was conducted from October 2018 to March 2019 at nine governmental TB-culture laboratories and 34 randomly selected GeneXpert® MTB/RIF (Xpert® MTB/RIF) testing health facilities in Ethiopia. Participating health facilities were interviewed and laboratory documents and records present since 2017 were observed. Prior to the data collection, training was given to the data collectors. Descriptive statistics were used to produce results and were presented with tables and graphs. RESULTS From a total of 34 Xpert® MTB/RIF testing laboratories, 50% run Internal Quality Control (IQC) for Acid-Fast Bacillus (AFB) Microscopy and 67.6% had lot-to-lot verification of staining reagents. For the Xpert® MTB/RIF assay, a lot-to-lot verification of cartridge and method validation was performed only in 8.8%and 20.6% of Xpert® MTB/RIF testing laboratories respectively. All TB-culture laboratories included in the study ran negative control (start and end IQC) during TB-culture sample processing and performed lot-to-lot verification for Mycobacteria Growth Indicator Tube (MGIT) in 88.9% of TB-culture laboratories. External Quality Assessment (EQA) Proficiency Testing (PT) for AFB microscopy is practiced in 79.4% Xpert® MTB/RIF testing laboratories and 100.0% for the Xpert® MTB/RIF assay. TB-Culture PT participation practice among TB-culture laboratories was 88.9%. A major challenge for health facilities during PT participation was the AFB PT-sample transportation delay (40.7%) and the Xpert® MTB/RIF assay EQA-PT feedback missing (38.2%). CONCLUSION This assessment reveals that IQC for AFB microscopy, lot-to-lot verification, method validation, and equipment calibration were not well-practiced. The majority of TB diagnostic health facility laboratories had EQA-PT participation practice, but a significant gap in PT-sample transportation and missing feedback was identified.
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Affiliation(s)
- Yeshiwork Abebaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology, and Parasitology College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Kebede
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kirubel Eshetu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ephrem Tesfaye
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Waganeh Sinshaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology, and Parasitology College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Misiker Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Betselot Zerihun
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology, and Parasitology College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melak Getu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology, and Parasitology College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Seid
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anteneh Yalew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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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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Donovan G, Ong SK, Song S, Ndefru N, Leang C, Sek S, Sadate-Ngatchou P, Perrone LA. Remote Mentorship Using Video Conferencing as an Effective Tool to Strengthen Laboratory Quality Management in Clinical Laboratories: Lessons From Cambodia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:689-698. [PMID: 33361236 PMCID: PMC7784067 DOI: 10.9745/ghsp-d-20-00128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
This program to strengthen laboratory quality management systems in Cambodia demonstrated significant improvements in conformity to ISO 15189 standards in participating laboratories, correlating with laboratory participation time in video conference training activities led by quality improvement mentors over the program implementation period. Background: Providing professional development opportunities to staff working in clinical laboratories undergoing quality improvement programs can be challenged by limited funding, particularly in resource-limited countries such as Cambodia. Using innovative approaches such as video conferencing can connect mentors with practitioners regardless of location. This study describes and evaluates the methods, outputs, and outcomes of a quality improvement program implemented in 12 public hospital laboratories in Cambodia between January 2018 and April 2019. The program used mixed intervention methods including both in-person and remote-access training and mentorship. Methods: Training outputs were quantified from the activity reports of program trainers and mentors. Program outcomes were measured by pre- and postimplementation audits of laboratory quality management system conformity to international standards. Variations in improved outcomes were assessed in relation to the time spent by laboratory personnel in video conference training and mentoring activity. An additional cross-sectional comparison described the difference in final audit scores between participating and nonparticipating laboratories. Results: Laboratories significantly improved their audit scores over the project period, showing significant improvement in all sections of the ISO 15189 standard. Pre- and postaudit score differences and laboratory personnel participation time in remote mentoring activities showed a strong monotonic relationship. Average input per laboratory was 6,027±2,454 minutes of participation in video conference activities with mentors. Audit scores of participating laboratories were significantly higher than those of laboratories with no quality improvement program. Conclusion: Laboratories improved significantly in ISO 15189 conformity following structured laboratory quality management systems training supported by remote and on-site mentoring. The correlation of laboratory participation in video conference activities highlights the utility of remote video conferencing technology to strengthen laboratories in resource-limited settings and to build communities of practice to address quality improvement issues in health care. These findings are particularly relevant in light of the COVID-19 pandemic.
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Affiliation(s)
- Grant Donovan
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, USA
| | - Siew Kim Ong
- International Training and Education Center for Health, Cambodia, Phnom Penh, Cambodia
| | - Sophanna Song
- International Training and Education Center for Health, Cambodia, Phnom Penh, Cambodia
| | - Nayah Ndefru
- International Training and Education Center for Health, Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, USA
| | - Chhayheng Leang
- International Training and Education Center for Health, Cambodia, Phnom Penh, Cambodia
| | - Sophat Sek
- International Training and Education Center for Health, Cambodia, Phnom Penh, Cambodia
| | - Patricia Sadate-Ngatchou
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, USA
| | - Lucy A Perrone
- International Training and Education Center for Health, Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, WA, USA.
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Homolka S, Zallet J, Albert H, Witt AK, Kranzer K. Introduction of quality management in a National Reference Laboratory in Germany. PLoS One 2019; 14:e0222925. [PMID: 31613905 PMCID: PMC6793863 DOI: 10.1371/journal.pone.0222925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background High quality diagnostic services are crucial for tuberculosis (TB) diagnosis, treatment and control. A strong laboratory quality management system (QMS) is critical to ensuring the quality of testing and results. Recent initiatives to improve TB laboratory quality have focused on low and middle-income countries, but similar issues also apply to high-income countries. Methods and findings Using a multipronged approach reviews of facilities, equipment, processes (purchasing, pre-analytic, analytic and post-analytic), staff, health and safety, documentation, information management and organization based on the ISO 15189 and the twelve quality system essentials were conducted between October 2015 and January 2016 at the National TB Reference Laboratory in Germany. Outcome assessment included proportion of smear positive slides, proportion of contaminated liquid cultures and DNA contamination rates before and after implementation of QMS. The odds ratio for these outcomes was calculated using a before/after comparison. Reviews highlighted deficiencies across all twelve quality system essentials and were addressed in order of priority and urgency. Actions aimed at improving analytical quality, health and safety and information management were prioritised for initial implementation in parallel with each other. The odds ratio for a sample to be tested as microscopically positive increased by 2.08 (95%CI 1.41–3.06) comparing the time before with the time after implementation of quality managed fluorescence microscopy. Liquid culture contamination rates decreased from 23.6- 7.6% in April-July 2016 to <10% in November 2017-March 2018. The proportion of negative controls showing evidence of DNA contamination decreased from 38.2% in 2013 to 8.1% in 2017, the corresponding odds ratio was 0.14 (95%CI 0.07–0.29). Conclusion This study showed marked improvement on quality indicators after implementation of a QMS in a National TB Reference Laboratory. The challenges and lessons learned in this study are valuable not just for high-income settings, but are equally generalizable to other laboratories.
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Affiliation(s)
- Susanne Homolka
- National Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
- * E-mail:
| | - Julia Zallet
- National Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
| | - Heidi Albert
- Foundation for Innovative New Diagnostics (FIND) South Africa, Cape Town, South Africa
| | - Anne-Kathrin Witt
- National Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Katharina Kranzer
- National Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
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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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Girma M, Desale A, Hassen F, Sisay A, Tsegaye A. Survey-Defined and Interview-Elicited Challenges That Faced Ethiopian Government Hospital Laboratories as They Applied ISO 15189 Accreditation Standards in Resource-Constrained Settings in 2017. Am J Clin Pathol 2018; 150:303-309. [PMID: 29992301 DOI: 10.1093/ajcp/aqy049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The World Health Organization African Regional Office recommends ISO 15189 standards to improve performance quality in sub-Saharan African laboratories. We specify challenges Ethiopian laboratorians encountered applying ISO 15189 standards. METHODS From a structured survey at 12 Ethiopian government hospitals, 175 laboratory staff replied; all were aware of the ISO standards and 138 had been involved in the ISO 15189 inspection process. In addition, 11 laboratory heads, 10 quality officers, and three medical directors were interviewed in depth. RESULTS Half or more respondents identified six challenges obstructing accreditation to a "large" or "very large" degree: (1) low management support, (2) inadequate training, (3) insufficient infrastructure, (4) excessive documentation, (5) little mentorship, and (6) increased accreditation-related workload. Interviewees added (7) poor equipment, (8) unavailable/poor-quality reagents, and (9) high staff turnover. CONCLUSIONS The survey and interviews specified nine major challenges for Ethiopian government hospital laboratories that seriously obstruct meeting ISO 15189 demands.
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Affiliation(s)
- Mekonnen Girma
- School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adinew Desale
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fatuma Hassen
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abay Sisay
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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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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Luman ET, Yao K, Nkengasong JN. A comprehensive review of the SLMTA literature part 2: Measuring success. Afr J Lab Med 2014; 3:276. [PMID: 29043201 PMCID: PMC5637800 DOI: 10.4102/ajlm.v3i2.276] [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: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 11/20/2022] Open
Abstract
Background Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented in 617 laboratories in 47 countries. Objective We completed a systematic review of the published literature on SLMTA. The review consists of two companion papers; this article examines quantitative evidence presented in the publications along with a meta-analysis of selected results. Methods We identified 28 published articles with data from SLMTA implementation. The SLMTA programme was evaluated through audits based on a standard checklist, which is divided into 12 sections corresponding to the 12 Quality System Essentials (QSEs). Several basic service delivery indicators reported by programmes were also examined. Results for various components of the programme were reviewed and summarised; a meta-analysis of QSE results grouped by the three stages of the quality cycle was conducted for 126 laboratories in 12 countries. Results Global programme data show improved quality in SLMTA laboratories in every country, with average improvements on audit scores of 25 percentage points. Meta-analysis identified Improvement Management as the weakest stage, with internal audit (8%) and occurrence management (16%) showing the lowest scores. Studies documented 19% – 95% reductions in turn-around times, 69% – 93% reductions in specimen rejection rates, 76% – 81% increases in clinician satisfaction rates, 67% – 85% improvements in external quality assessment results, 50% – 66% decreases in nonconformities and 67% increases in staff punctuality. Conclusions The wide array of results reported provides a comprehensive picture of the SLMTA programme overall, suggesting a substantive impact on provision of quality laboratory services and patient care. These comprehensive results establish a solid data-driven foundation for program improvement and further expansion.
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Affiliation(s)
- Elizabeth T Luman
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Katy Yao
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - John N Nkengasong
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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Yao K, Luman ET. Evidence from 617 laboratories in 47 countries for SLMTA-driven improvement in quality management systems. Afr J Lab Med 2014; 3. [PMID: 26753132 PMCID: PMC4706175 DOI: 10.4102/ajlm.v3i2.262] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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. Objectives 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-tailed t-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. Conclusion 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.
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Affiliation(s)
- Katy Yao
- International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Elizabeth T Luman
- International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Luman ET, Yao K, Nkengasong JN. A comprehensive review of the SLMTA literature part 1: Content analysis and future priorities. Afr J Lab Med 2014; 3:265. [PMID: 29043200 PMCID: PMC5637796 DOI: 10.4102/ajlm.v3i2.265] [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] [Received: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 11/26/2022] Open
Abstract
Background Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented widely throughout Africa, as well as in the Caribbean, Central and South America, and Southeast Asia. Objective We compiled results from local, national and global studies to provide a broad view of the programme and identify directions for the future. The review consists of two companion papers; this paper focuses on content analysis, examining various thematic components of the SLMTA programme and future priorities. Methods A systematic literature search identified 28 published articles about implementing the SLMTA programme. Results for various components of the SLMTA programme were reviewed and summarised. Results Local and national studies provide substantial information on previous experiences with quality management systems; variations on SLMTA implementation; building human resource capacity for trainers, mentors and auditors; the benefits and effectiveness of various types of mentorship; the importance of management buy-in to ensure country ownership; the need to instill a culture of quality in the laboratory; success factors and challenges; and future directions for the programme. Conclusions Local, national and global results suggest that the SLMTA programme has been overwhelmingly successful in transforming laboratory quality management. There is an urgent need to move forward in four strategic directions: progression (continued improvement in SLMTA laboratories), saturation (additional laboratories within countries that have implemented SLMTA), expansion (implementation in additional countries), and extension (adapting SLMTA for implementation beyond the laboratory), to lead to transformation of overall health systems and patient care.
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Affiliation(s)
- Elizabeth T Luman
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Katy Yao
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - John N Nkengasong
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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Audu RA, Onubogu CC, Nwokoye NN, Ofuche E, Baboolal S, Oke O, Luman ET, Idigbe EO. Improving quality in national reference laboratories: The role of SLMTA and mentorship. Afr J Lab Med 2014; 3:200. [PMID: 29043183 PMCID: PMC5637787 DOI: 10.4102/ajlm.v3i2.200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/08/2014] [Indexed: 11/07/2022] Open
Abstract
Background The Nigerian Institute of Medical Research houses two reference laboratories: the virology and tuberculosis laboratories. Both were enrolled in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. Objective To describe the impact of SLMTA and discuss factors affecting the results, with an emphasis on mentorship. Methods The SLMTA programme was implemented from April 2010 through November 2012. Participants attended three workshops and executed quality improvement projects; laboratory auditors evaluated performance using a standard checklist. The virology laboratory did not receive mentorship; however, the tuberculosis laboratory had an international mentor who visited the laboratory four times during the programme, spending two to four weeks embedded within the laboratory during each visit. Results There was an overall improvement in the performance of both laboratories, with the virology laboratory increasing 13% (from 80% at baseline to 93% at exit audit) and the tuberculosis laboratory increasing 29% (from 66% to 95%). These scores were maintained nine months later at the surveillance audit. Conclusion The SLMTA programme resulted in improved and sustained quality management performance for both laboratories. Mentoring was a possible factor in the substantial improvement made by the tuberculosis laboratory and should be considered in order to augment the training received from the SLMTA workshops.
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Affiliation(s)
- Rosemary A Audu
- Human Virology Laboratory, Nigerian Institute of Medical Research, Nigeria
| | - Catherine C Onubogu
- National Tuberculosis Reference Laboratory, Nigerian Institute of Medical Research, Nigeria
| | - Nkiru N Nwokoye
- National Tuberculosis Reference Laboratory, Nigerian Institute of Medical Research, Nigeria
| | - Eke Ofuche
- AIDS Prevention Initiative in Nigeria, Nigeria
| | | | - Odafen Oke
- US Centers for Disease Control and Prevention, Nigeria
| | | | - Emmanuel O Idigbe
- National Tuberculosis Reference Laboratory, Nigerian Institute of Medical Research, Nigeria
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