An article published by the United States Centers for Disease Control and Prevention (CDC) in the 28 May 2021 issue of the Morbidity and Mortality Weekly Report (MMWR) documents an improvement in the number of people living with HIV (PLHIV) receiving antiretroviral treatment from 2013 to 2018 among eight sub-Saharan African countries. The data show over 85% viral suppression among treated persons, in all eight countries supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR), which highlights substantial progress in achieving the third of the UNAIDS 90-90-90 HIV treatment targets over the years. Such commendable outcomes have been made possible through the funding and efforts of PEPFAR and other partners involved in laboratory system strengthening using adequately targeted interventions.
Country Teams meet for a breakout session at LabCoP’s 2019 Face-to-Face meeting in Addis Ababa, Ethiopia.
What do these results mean for the continent’s viral load (VL) programmes, laboratory systems and public health? ASLM supports five of the eight countries mentioned in the article through its Laboratory Systems Strengthening Community of Practice (LabCoP) programme, supported by the Bill and Melinda Gates Foundation. LabCoP assists countries in identifying laboratory system gaps and prioritising interventions proven to work, based on evidence obtained through annual country self-assessment exercises. LabCoP and global partners provide hands-on guidance to VL programmes and laboratory country teams to develop well-informed work plans supporting requests for funding to the PEPFAR country operational plans. The results reported in MMWR confirm that the LabCoP theory of action is an enabler of success.
The MMWR article highlights test turn-around time, test demand, result utilization and sample transport mechanisms in the testing cascade as key considerations for successful VL testing programs. Interestingly, challenges in these key areas have been encountered by LabCoP countries when responding to the COVID-19 pandemic, underscoring how addressing laboratory system weaknesses could benefit diagnostic programmes for various diseases.
As part of its mission to identify and address gaps in laboratory systems underlying the VL testing cascade, LabCoP determined the need for critical review and improvement of VL testing monitoring and evaluation (M&E) systems. Strong M&E systems are necessary to ensure that VL testing adequately contributes to clinical and public health decisions, and adapts to changes, such as the ones created by the surge in COVID-19 testing, so that gains toward the 3rd 90 (now 95) are maintained. To this end, ASLM, in partnership with United States CDC, the World Health Organization, the Clinton Health Access Initiative and other partners, established an M&E sub-community of practice (CoP) within LabCoP, composed of over 90 members from 14 African countries. The M&E sub-CoP is a forum for discussion of common challenges and best practices to address the M&E needs of national VL programmes.
The model of support provided by PEPFAR in collaboration with ASLM and other partners can be replicated with other global donors in non-PEPFAR-supported countries to improve laboratory systems across the African continent.
Read the article in Morbidity and Mortality Weekly Report from the US CDC here.
Authors: Dr Collins Otieno and Dr Pascale Ondoa
Editors: Mrs El-shama Nwoko, Mrs Bethanie Rammer
About ASLM
Established in 2011, the African Society for Laboratory Medicine (ASLM) is a pan-African professional body focused on improving healthcare by strengthening all aspects of laboratories including workforce strengthening, quality improvement and accreditation, regulation(s) harmonization, networks strengthening, and advocacy and communication strengthening. Laboratory testing is pivotal for disease diagnosis, epidemiological surveillance, outbreak investigation, and treatment initiation and monitoring, as well as research and development. ASLM addresses these challenges by working collaboratively with governments; national, regional and international organizations; implementing partners; the private sector; and other agencies to achieve its strategic vision goals. ASLM is endorsed by the African Union with support from the World Health Organization, Africa CDC, the US CDC, the US President’s Emergency Plan for AIDS Relief, the World Bank, the Clinton Foundation, UNAIDS, and others.