Key Takeaways from LabCoP’s ASLM2021 Satellite Session
On the closing day of ASLM2021, LabCoP held a satellite session on the Role of Diagnostic Integration in Strengthening Laboratory Systems. Panellists comprised of donors, programme managers, and representatives from Abbott, Cepheid, Hologic, and Roche, who shared unique perspectives on the need to promote testing integration. The molecular testing instrument marketplace has evolved to allow integrated testing in recent years, and integrated testing on existing platforms has been critical to the COVID-19 response in resource-limited settings. Shared experiences from Tanzania and Burkina Faso demonstrated benefits such as lower testing costs, greater access, and better patient management, without overwhelming device capacity.
Manufacturers continuously support testing integration by providing extensive platform networks and timely access to engineers to ensure uninterrupted service. Manufacturers have also been very open to new approaches to promote integrated testing, mainly through facilitating more inclusive and lower pricing deals. For example, Abbott, Cepheid, Hologic and Roche have each introduced pricing mechanisms that ensure that key elements like service, maintenance, training, and spare parts are bundled in one price without hidden costs. Manufacturers also partner with countries to identify challenges and co-create solutions and innovations for sample collection, transport, and testing, and to develop digital tools for utilising results of multiple tests run on the same instruments.
A representative from the tuberculosis programme described the ‘fear’ of possible deprioritisation of tuberculosis testing in favour of HIV testing as one key barrier to testing integration. A lack of coordination between disease programmes has also contributed to delays in implementing integrated testing. Some levels of coordination have been realised nationally at the funding application stage (e.g., The Global Fund applications) but not at the implementation stage. Disease programmes should define national goals for integration and not simply a combined list of goals from different disease programmes.
Funders have set key performance measures that manufacturers strive to achieve in support of integrated testing. However, some systemic and structural issues in the design of funding for diagnostics still need to change. Funding for diagnostics should target integrated diagnostics, rather than being disease-specific as is currently the case.
Although countries and stakeholders are willing to redesign laboratory networks based on evidence, the traction of this change is slow and needs to build momentum. A diagnostic network optimisation approach should also be adopted to identify opportunities for the targeted integration of (components of) diagnostic network optimisation diagnostic systems.
To fully achieve the benefits of testing integration for all patients, assessments of the feasibility and opportunity to expand testing integration should go beyond diagnostic instruments. Manufacturers have expressed willingness to collaborate more and should be included in discussions around integration to support global health and people-centric healthcare. To reach more people, testing needs to be decentralised. Manufacturers’ research and development portfolios thus strive to produce smaller instrumentation to reach decentralised settings. ASLM LabCoP and partners have started developing a tool to allow countries to track and monitor progress by measuring integration through the patient lens using a standardised approach. LabCoP is committed to engaging all stakeholders to improve service delivery.