Building Laboratory Capacity to Strengthen Health Systems

Orozco, Juan Daniel; Greenberg, L.; Desai, Ishaan K.; Anglade, Fabienne; Ruhangaza, Deogratias; Johnson, Mira; Ivers, Louise C.; Milner, Danny A.; Farmer, Paul

doi:10.1016/j.cll.2017.10.008

Cited by 12 publications

(10 citation statements)

References 33 publications

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“…These labs had limited capacity to perform even basic tissue processing functions such as making tissue blocks, mounting slides, and hematoxylin and eosin staining, whereas more advanced testing, including immunohistochemistry and molecular diagnostics, was unavailable anywhere in the country. In order to mitigate these deficiencies, HUM developed a formal collaboration with external partners, including Dana‐Farber Cancer Institute and Brigham and Women's Hospital, whereby many patients treated at HUM had their tissue samples sent outside the country for diagnostic pathology [39]. A pathology lab became functional at HUM in 2016.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Fadelu

Damuse²,

Lormil³

et al. 2020

The Oncologist

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Background There are few studies on breast cancer outcomes in the Caribbean region. This study identified a retrospective cohort of female patients with nonmetastatic breast cancer in Haiti and conducted survival analyses to identify prognostic factors that may affect patient outcomes. Methods The cohort included 341 patients presenting between June 2012 and December 2016. The primary endpoint was event‐free survival (EFS), defined as time to disease progression, recurrence, or death. Descriptive summaries of patient characteristics and treatments were reported. Survival curves were plotted using Kaplan‐Meier estimation. Multivariate survival analyses were performed using Cox proportional hazards regression. Results Median age at diagnosis was 49 years, with 64.2% being premenopausal. Most patients (55.1%) were staged as locally advanced. One hundred and sixty patients received neoadjuvant therapy: 33.3% of patients with early stage disease and 61.2% of those with locally advanced stage disease. Curative‐intent surgery was performed in 278 (81.5%) patients, and 225 patients received adjuvant therapy. Adjuvant endocrine therapy was used in 82.0% of patients with estrogen receptor–positive disease. During the follow‐up period, 28 patients died, 77 had disease recurrence, and 10 had progressive disease. EFS rates at 2 years and 3 years were 80.9% and 63.4%, respectively. After controlling for multiple confounders, the locally advanced stage group had a statistically significant adjusted hazard ratio for EFS of 3.27 compared with early stage. Conclusion Patients with nonmetastatic breast cancer in Haiti have more advanced disease, poorer prognostic factors, and worse outcomes compared with patients in high‐income countries. Despite several limitations, curative treatment is possible in Haiti. Implications for Practice Patients with breast cancer in Haiti have poor outcomes. Prior studies show that most Haitian patients are diagnosed at later stages. However, there are no rigorous studies describing how late‐stage diagnosis and other prognostic factors affect outcomes in this population. This study presents a detailed analysis of survival outcomes and assessment of prognostic factors in patients with nonmetastatic breast cancer treated in Haiti. In addition to late‐stage diagnosis, other unfavorable prognostic factors identified were young age and estrogen receptor‐negative disease. The study also highlights that the availability of basic breast cancer treatment in Haiti can lead to promising early patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Fadelu

Damuse²,

Lormil³

et al. 2020

The Oncologist

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“…There is a paucity of adequate microbiological diagnostic capacity in many settings, limiting clinicians’ ability to tailor antimicrobial therapy to local pathogen and resistance profiles or individual patients’ pathogen sensitivity and resistance patterns, as is recommended in many sepsis management guidelines [ 40 ]. Diagnostic capacity extends beyond just physical components of microbiology laboratories such as reliable access to consumable supplies, and includes staffing with adequate numbers of appropriately trained professionals such as phlebotomists and laboratory technicians, as well as necessary oversight and enforcement of good clinical laboratory practice [ 41 ].…”

Section: Sepsis Highlights Health System Challengesmentioning

confidence: 99%

The global burden of sepsis: barriers and potential solutions

et al. 2018

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Sepsis is a major contributor to the global burden of disease. The majority of sepsis cases and deaths are estimated to occur in low and middle-income countries. Barriers to reducing the global burden of sepsis include difficulty quantifying attributable morbidity and mortality, low awareness, poverty and health inequity, and under-resourced and low-resilience public health and acute health care delivery systems. Important differences in the populations at risk, infecting pathogens, and clinical capacity to manage sepsis in high and low-resource settings necessitate context-specific approaches to this significant problem. We review these challenges and propose strategies to overcome them. These strategies include strengthening health systems, accurately identifying and quantifying sepsis cases, conducting inclusive research, establishing data-driven and context-specific management guidelines, promoting creative clinical interventions, and advocacy.

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“…The absence of staff, stuff, space, and systems needed to detect outbreaks of infectious disease such as the recent Ebola epidemic in West Africa, and diagnose other medical conditions has underscored the need to not only set up diagnostic equipment in places where it is scarce, but also invest resources into training laboratory personnel. (p. 102) 10 Laboratories worldwide suffer from scarcities of skilled or qualified staff.…”

Section: Discussionmentioning

confidence: 99%

Establishing diagnostic training programs in resource-poor settings: The case of Sierra Leone

Presser

2020

African Journal of Laboratory Medicine

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Building Laboratory Capacity to Strengthen Health Systems

Cited by 12 publications

References 33 publications

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

The global burden of sepsis: barriers and potential solutions

Establishing diagnostic training programs in resource-poor settings: The case of Sierra Leone

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