Capacity building in national influenza laboratories – use of laboratory assessments to drive progress

Abstract

BackgroundLaboratory testing is a fundamental component of influenza surveillance for detecting novel strains with pandemic potential and informing biannual vaccine strain selection. The United States (U.S.) Centers for Disease Control and Prevention (CDC), under the auspices of its WHO Collaborating Center for Influenza, is one of the major public health agencies which provides support globally to build national capacity for influenza surveillance. Our main objective was to determine if laboratory assessments supported capacity building efforts for improved global influenza surveillance.MethodsIn 2010, 35 national influenza laboratories were assessed in 34 countries, using a standardized tool. Post-assessment, each laboratory received a report with a list of recommendations for improvement. Uptake of recommendations were reviewed 3.2 mean years after the initial assessments and categorized as complete, in-progress, no action or no update. This was a retrospective study; follow-up took place through routine project management rather than at a set time-point post-assessment. WHO data on National Influenza Centre (NIC) designation, External Quality Assessment Project (EQAP) participation and FluNet reporting was used to measure laboratory capacity longitudinally and independently of the assessments. All data was further stratified by World Bank country income category.ResultsAt follow-up, 81 % of 614 recommendations were either complete (350) or in-progress (145) for 32 laboratories (91 % response rate). The number of countries reporting to FluNet and the number of specimens they reported annually increased between 2005, when they were first funded by CDC, and 2010, the assessment year (p < 0.01). Improvements were also seen in EQAP participation and NIC designation over time and more so for low and lower-middle income countries.ConclusionsAssessments using a standardized tool have been beneficial to improving laboratory-based influenza surveillance. Specific recommendations helped countries identify and prioritize areas for improvement. Data from assessments helped CDC focus its technical assistance by country and region. Low and lower-middle income countries made greater improvements in their laboratories compared with upper-middle income countries. Future research could include an analysis of annual funding and technical assistance by country. Our approach serves as an example for capacity building for other diseases.

Can mentorship improve laboratory quality? A case study from influenza diagnostic laboratories in Southeast Europe

“…We utilized qualitative methods as a formative approach to evaluating the perceived value of mentorship and the lessons learned [8–10]. To support the heterogeneity of the differing laboratory contexts, we utilized grounded theory, which allows for the unique experiences of each laboratory and mentor to be discussed and facilitated through a standard methodology [11]. Over 5 days, a trained qualitative evaluator from CDC who was not familiar with the program, and did not participate in the program, conducted face-to-face, semi-structured interviews with the six laboratory mentees and four mentors (26 questions), with a stakeholder from WHO regional office for Europe most directly involved in the program (14 questions) and with one key stakeholder from SECID who is responsible for coordinating capacity building for influenza infectious disease surveillance in the region (14 questions).…”

“…A program evaluator with qualitative analysis training independently coded transcripts using grounded theory to identify themes, and to later analyze and interpret them through content analysis [11, 12, 14] . Cleaned transcripts were organized into Microsoft Excel by respondent and question number, and codes and sub-codes were manually entered for each question.…”

Measuring influenza laboratory capacity: use of a tool to measure improvements

“…In addition, as other examples of progress, laboratories had purchased either equipment maintenance agreements or hired maintenance staff and developed and implemented written protocols for testing and biosafety. A recent article provides detailed analysis of all the recommendations made during the first assessment and the documented status garnered from either a follow up assessment or from laboratory personnel updates [10].…”

“…Final reports from each assessment were reviewed to identify recommendations and status updates were obtained during a follow-up assessment to gather information on which of the original recommendations were implemented and which items remained pending. Analysis of the recommendation results is previously discussed [10].…”

Assessment of National Public Health and Reference Laboratory, Accra, Ghana, within Framework of Global Health Security

“…The CDC International Measles and Rubella Laboratory Capacity Review tool was created in Excel (Microsoft, Redmond, WA, USA) by using the International Influenza laboratory capacity tool ( 8 , 9 ) as a model. The tool is organized into 8 sections.…”