Diagnostic Integration Efforts in Seven LabCoP Countries

LabCoP Mgt team with Nhlangano Tuberculosis Laboratory staff in Eswatini
LabCoP Management team with Nhlangano Tuberculosis Laboratory staff in Eswatini

Between June and November 2021, the LabCoP Management Team visited seven LabCoP participating countries, Burkina Faso, Burundi, Eswatini, Nigeria, Sierra Leone, South Sudan, and Tanzania, to facilitate country self-assessments, discuss progress in the implementation of work plans, and better understand country priorities. The Management Team also conducted high-level advocacy for laboratory systems strengthening, engaged implementing partners and stakeholders from the tuberculosis programme, and identified best practices for sharing in future ECHO sessions.

LabCoP Management team with Tanzania National TB Program Manager
LabCoP Management team with Tanzania National TB Program Manager

In line with LabCoP’s expanding scope and following the laboratory service disruptions experienced during the COVID-19 pandemic, the country visits focused on strengthening diagnostic integration. The team reviewed integration use cases, the stakeholder landscape, national policies/regulations supporting integration, and implementation considerations. Diagnostic integration was already being implemented for HIV and tuberculosis in six countries, and for COVID-19 in five of those six. Some countries also included Ebola and human papillomavirus. In all six countries, the GeneXpert instrument was selected for decentralised testing, in addition to centralised platforms from Roche and Hologic. Diagnostic integration was coordinated by technical working groups comprising members from disease programmes, with meetings held bi-annually (e.g., Burkina Faso) or quarterly (e.g., Tanzania). Regarding policy and regulation, more effort is needed to include diagnostic integration into national laboratory strategic plans and develop priority diagnostic lists. Currently, only Nigeria has a national essential diagnostics list.

LabCoP Mgt team at Nigeria CDC laboratory in Abuja
LabCoP Management team at Nigeria CDC laboratory in Abuja

Most countries were aware of the number and capacity utilisation of instruments within the country. All the GeneXpert instruments in Tanzania had existing maintenance contracts. At least two countries, Burkina Faso and Nigeria, possessed a geographic information system that maps laboratory capacity and can inform integration toward expanding population coverage for laboratory services.

LabCoP Mgt team tours the National Molecular Reference Laboratory in Mbabane, Eswatini
LabCoP Management team tours the National Molecular Reference Laboratory in Mbabane, Eswatini

At least four countries had developed or expanded their integrated specimen referral system to support testing. Clear guidance on testing prioritisation was also available in two countries: Tanzania (tuberculosis>COVID-19>early infant HIV diagnosis>viral load) and Burkina Faso (COVID-19>tuberculosis>early infant HIV diagnosis>viral load). One stakeholder from Nigeria indicated that supporting systems for integrated testing needed to be addressed to maintain testing targets for integrated tests.

LabCoP Mgt team with Burundi LabCoP team during self-assessmernt exeecise
LabCoP Management team with Burundi LabCoP team during self-assessment exercise

While great effort had been made by these countries, none were conducting monitoring and evaluation of key indicators of integration, including cost savings, population coverage of testing services, testing levels across diseases/programmes, and the number of evidence-based clinical management cases. LabCoP is developing an Integration Readiness Assessment tool, based on the capability maturation model, to assist countries to self-assess their progress toward diagnostic integration. LabCoP also intends to facilitate the sharing of best practices for optimising integration services and update the decision-making matrix for the improvement of integration services.