DNO Sub-CoP

What is the DNO Sub-CoP?

The Diagnostic Network Optimisation Sub-community of Practice (DNO Sub-CoP) is a dedicated segment of ASLM’s LabCoP. The DNO Sub-CoP is a collaboration of ASLM and FIND, funded by the Bill & Melinda Gates Foundation. The DNO Sub-CoP gathers country teams (made up of laboratorians, clinicians, and representatives from ministries of health who support DNO activities in their country) and stakeholders (implementing partners, regulatory and technical agencies) who share challenges, solutions and best practices for optimising their diagnostic network.

Why a DNO Sub-CoP?

Globally, diagnosis is the biggest gap in the cascade of care. In low- and middle-income countries (LMICs), including in Africa, 35–62% of populations are lacking access to essential diagnostics for six common medical conditions. This gap in access is exacerbated at primary healthcare level. The situation is mirrored for outbreak response, where the capacity to detect outbreaks in the African region, as assessed through the Joint External Evaluation (JEE) process, was only scored at 44%.

These data evidence how laboratory networks in Africa do not effectively deliver services for clinical (UHC) and public health (IHR) functions and how diagnostic services are generally not equitably available or accessible to the population. Furthermore, investments for optimising laboratory networks in the context of limited resources are often lacking or are not driven by context relevant and geo-localised, geographic information system (GIS) data on laboratory capacity.

DNO is a geospatial data analytics approach that informs diagnostic strategies and operational planning consistent with national health goals. DNO involves:

definition of the scope and the alignment of stakeholders, including ministries of health, partners and donor agencies involved in lab systems strengthening
collection, mapping, and spatial analysis of data on functions and capacities in a national laboratory network
selection and development of scenarios to model and optimise the network
implementation of changes and monitoring of associated impact to achieve strengthening of diagnostic systems.

Through evaluation of testing demand, testing capacity and utilisation, cost efficiency, access to services, and application of real-life constraints, DNO allows countries to determine how to provide the greatest access to equitable and timely diagnostic services, while maximising overall efficiencies of laboratory systems. DNO informs interventions needed to achieve disease goals and health equity and enables prioritisation of high-impact investments in a context of limited resources.

Many tools, software and strategies are available to support DNO, with the need to identify the most suitable approaches and the most critical-use cases. This requires that both countries and experts rolling-out DNO tools align their thinking and knowledge for increased effectiveness and impact of DNO. The DNO Sub-CoP aims to improve the uptake and the quality of DNO processes in LabCoP countries, to promote data-driven investments for effective laboratory networks optimisation.

The Diagnostic Network Optimisation Sub-CoP Theory of Action

Resources

Find diagnostic network optimisation resources here!

How to Join

A LabCoP country team may send a Letter of Intent to join the DNO Sub-CoP to Dr Marguerite Massinga Loembe email and CC Dr Collins Otieno Odhiambo email.

Programmes and tools for DNO:

ASLM’s LabMap: The LabMaP project hosts a platform for the rapid collection, storage and analysis of geo-localised data on laboratory capacity.
FIND’s DNO Info Page: More information about diagnostic network optimisation on FIND’s website.
OptiDx: An open-access web-based disease-agnostic tool to conduct DNO analyses.

Guidance, manuals & reports:

Diagnostic Network Optimisation Guide: This guide provides an overview of DNO: concepts of DNO, processes to conduct a DNO analysis, data requirements, software solutions for conducting DNO and how to use DNO analysis outputs to inform decision-making.
Molecular Diagnostics Integration Global Meeting Report: This report includes the proceedings of a meeting with countries and key stakeholders in diagnostics convened by WHO and ASLM to discuss concrete ways to improve and increase access to integrated multiplex technologies and determine how they can be translated into public health policy to achieve global impact.
Beyond Diagnostic Network Optimisation: a Network Approach to Strengthening and Scaling-up Laboratory Services: This guide, published by USAID and PEPFAR, describes the experience of countries, partners, and donors in implementing different aspects of the network approach to lab services, to achieve tangible and measurable improvements in addressing country diagnostic testing demand across multiple disease areas.

Publications:

Strengthening health systems through essential diagnostic lists and diagnostic network optimization: A national essential diagnostic list (EDL) allows countries to select priority diagnostics that are appropriate for their disease burden, health infrastructure and current diagnostic capacity and place them at different levels of a country’s healthcare system. This opinion paper describes how the DNO approach can be used to guide implementation of an EDL and ensure that a country’s diagnostic resources are implemented in the most effective manner.
Bringing Data Analytics to the Design of Optimised Diagnostic Networks in LMICs: Process, Terms and Definitions (Nichols, K et al.): This review paper outlines the goals of DNO and steps in the process and provides clarity on commonly used terms.
Use of Physical Accessibility Modelling in Diagnostic Network Optimisation: a Review (Chenes, C et al): This review paper aimed to determine if and how physical accessibility has been used to inform the optimisation of diagnostic networks.
Designing an Optimised Diagnostic Network to Improve Access to TB Diagnosis and Treatment in Lesotho (Albert, H et al): This paper illustrates the use of DNO to inform country-led decision-making processes around placement of new technologies and network optimisation strategies to improve access to TB diagnostic services.

Videos:

Diagnostic Network Optimisation: an Overview: This video provides an overview of the DNO approach, its role in supporting strategic planning and investments toward diagnostic systems strengthening and outline of key steps in the process.
Increasing Access and Efficiency of Dx Networks Using OptiDx: This satellite session co-hosted by Integrated Diagnostics Consortium (IDC) and FIND at the ASLM 2021 conference provides an introduction to DNO and OptiDx, including a brief demo of OptiDx and experiences from the use of this tool in Zambia.
OptiDx: Optimising Diagnostic Networks: This video illustrates how OptiDx can be used to perform DNO analysis.
IDDS Webinar: Improving Access to Tuberculosis Diagnostic Services through Geospatial Mapping: In this session, USAID-funded Infectious Disease Detection and Surveillance (IDDS) project and national TB programme partners share their experiences using the Laboratory Network Spatial Analysis. IDDS discusses key data sources, how they are used, and how countries can adopt the methodology.
Diagnostic Network Optimisation ECHO Session Library: Recordings of past ECHO sessions featuring presentations about DNO topics of interest.