Consolidating HIV testing in a public health laboratory for efficient and sustainable early infant diagnosis (EID) in Uganda

Kiyaga, Charles; Sendagire, Hakim; Joseph, Eleanor; Grosz, Jeff; McConnell, Ian; Narayan, Vijay; Esiru, Godfrey; Elyanu, Peter; Akol, Zainab; Kirungi, Wilford; Musinguzi, Joshua; Opio, Alex

doi:10.1057/jphp.2015.7

Cited by 15 publications

(15 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To ensure widespread access, test networks are required, comprising a tiered network of laboratories servicing a wider network of health facilities. The functioning of such networks relies heavily on testing systems such as sample referral to ensure access to laboratory capacity over wide geographic areas, health data systems to ensure rapid dissemination of test results for clinical, programmatic and surveillance uses, and quality assurance to ensure reliable results irrespective of testing location . Laboratory networks have been strengthened in numerous countries, establishing active sample referral and results delivery connections between central and decentralized levels of the health care system.…”

Section: Improve Testing Efficiencymentioning

confidence: 99%

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Peter¹,

Zeh²,

Katz

et al. 2017

J Intern AIDS Soc

View full text Add to dashboard Cite

IntroductionThe scale‐up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point‐of‐care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low‐resource countries. The purpose of this commentary is to review the challenges and solutions from the large‐scale implementation of other diagnostic tests, namely nucleic‐acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale‐up of VL.DiscussionExperience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale‐up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow‐up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business.ConclusionsThe lessons and innovations from large‐scale EID and CD4 programs described here can be adapted to inform more effective scale‐up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost‐effective test access.

show abstract

Section: Improve Testing Efficiencymentioning

confidence: 99%

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Peter¹,

Zeh²,

Katz

et al. 2017

J Intern AIDS Soc

View full text Add to dashboard Cite

show abstract

“…The Uganda Sickle Surveillance Study (US3) was developed as a formal research partnership among academia, industry, and government to determine the distribution and burden of sickle cell trait and disease throughout the Republic of Uganda . The methodology for the US3 study involved a 1‐year cross‐sectional analysis of dried blood spots (DBS), which were originally collected from HIV‐exposed infants and toddlers across the country, as part of the CDC‐sponsored HIV Early Infant Diagnosis (EID) program in Uganda . After the DBS were tested for HIV at the Uganda Central Public Health Laboratories (CPHL), these samples were then tested for hemoglobin disorders using isoelectric focusing electrophoresis by locally trained staff.…”

Section: Introductionmentioning

confidence: 99%

Sickle cell screening in Uganda: High burden, human immunodeficiency virus comorbidity, and genetic modifiers

Kiyaga

Hernandez

Ssewanyana

et al. 2019

Pediatric Blood & Cancer

Self Cite

View full text Add to dashboard Cite

Background The Uganda Sickle Surveillance Study provided evidence for a large sickle burden among HIV‐exposed infants in Uganda. To date, however, no large scale screening program has been developed for Central or East Africa. Methods A 3‐year targeted sickle cell screening project in Uganda was designed by the Ministry of Health to (1) determine sickle cell trait and disease prevalence within high‐burden districts, (2) document the prevalence among HIV‐exposed and nonexposed children, (3) confirm previously suggested HIV comorbidity, and (4) estimate the co‐inheritance of known genetic modifiers of sickle cell disease. Results A total of 163 334 dried blood spot samples collected between April 2015 and March 2018 were analyzed, including 112 352 samples within the HIV Early Infant Diagnosis program. A high burden with >1% sickle cell disease was found within targeted East Central and Mid‐Northern districts, in both HIV‐exposed and nonexposed children. Based on crude birth‐rate data, 236 905 sickle cell trait births and 16 695 sickle cell disease births will occur annually in Uganda. Compared to sickle cell disease without HIV, the odds ratio of having sickle cell disease plus HIV was 0.50 (95% confidence interval = 0.40‐0.64, P < .0001). Alpha‐thalassemia trait and G6PD deficiency were common with sickle cell disease, but with different geospatial distribution. Conclusions High sickle cell burden and potential HIV comorbidity are confirmed in Uganda. Genetic modifiers are common and likely influence laboratory and clinical phenotypes. These prospective data document that targeted sickle cell screening is feasible and effective in Uganda, and support development of district‐level comprehensive care programs.

show abstract

“…Thus, although there are portable tests available (7 ), rubella is almost always diagnosed in central clinical laboratories. In resource-limited settings, transportation from rural communities to remote laboratories is often cost prohibitive (8 ), meaning that rubella infections (and attendant cases of CRS) routinely sweep through rural populations without testing or treatment (9 ).…”

mentioning

confidence: 99%

Digital Microfluidic Platform for the Detection of Rubella Infection and Immunity: A Proof of Concept

Lee

Choi

et al. 2015

Clinical Chemistry

View full text Add to dashboard Cite

BACKGROUND:Whereas disease surveillance for infectious diseases such as rubella is important, it is critical to identify pregnant women at risk of passing rubella to their offspring, which can be fatal and can result in congenital rubella syndrome (CRS). The traditional centralized model for diagnosing rubella is cost-prohibitive in resource-limited settings, representing a major obstacle to the prevention of CRS. As a step toward decentralized diagnostic systems, we developed a proof-of-concept digital microfluidic (DMF) diagnostic platform that possesses the flexibility and performance of automated immunoassay platforms used in central facilities, but with a form factor the size of a shoebox.

show abstract

Consolidating HIV testing in a public health laboratory for efficient and sustainable early infant diagnosis (EID) in Uganda

Cited by 15 publications

References 22 publications

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Sickle cell screening in Uganda: High burden, human immunodeficiency virus comorbidity, and genetic modifiers

Digital Microfluidic Platform for the Detection of Rubella Infection and Immunity: A Proof of Concept

Contact Info

Product

Resources

About