Public-Private Partnership Strengthens Global Laboratory Systems

Deficiencies in the health care systems in most countries supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) are enormous, and no single entity – neither governmental and non-governmental organizations nor industry – can meet these challenges alone. By joining hands to help host nations develop robust laboratory facilities, a partnership between PEPFAR and Becton, Dickinson and Company (BD) is maximizing limited resources and helping build sustainable improvements.

In the fight against HIV/AIDS in Africa, a strong laboratory system is critical to supporting prevention, treatment, and care interventions. For clinicians, laboratory data are essential to accurately assess the status of patients’ health, make accurate diagnoses, formulate treatment plans, and subsequently monitor the effects of treatment. The clinician must be able to trust the test results; therefore, the laboratory results must be accurate, reliable and timely.

One strategy being employed by PEPFAR to strengthen sustainable, integrated laboratory systems that provide quality diagnostic services is the establishment of strong public-private partnerships. On October 31, 2007, PEPFAR – through CDC and BD, a leading global medical technology company with laboratory expertise – launched a five-year public-private partnership, the first of its kind, to improve overall laboratory systems and services in African countries severely affected by HIV/AIDS and tuberculosis (TB).

The partnership, providing support of up to $18 million, is being initiated in eight African countries: Côte d’Ivoire, Ethiopia, Kenya, Malawi, Mozambique, South Africa, Tanzania, and Uganda. The partnership’s implementation strategy includes three key components developed in collaboration with Ministries of Health, National Reference Laboratories and implementing partners: country-specific laboratory strengthening programs based on National Laboratory Strategic Plans; fellowship programs for BD associates to work closely with implementing partners, and short-term technical assistance by both BD and PEPFAR partners to provide laboratory training and develop a framework to reach all levels of laboratory service.

The collaboration is greatly expanding the number of laboratory trainings offered to all PEPFAR-supported countries in Africa, and is increasing the number of health care workers trained to provide quality HIV testing and improved TB diagnostics. Currently, the partnership is providing curriculum and trainers to assist the PEPFAR-sponsored African Center for Integrated Laboratory Training in Johannesburg, South Africa.

In Uganda, the partnership is implementing Laboratory Quality Management Training for all labs performing CD4 testing and assisting in the development of a specimen referral system for the National Tuberculosis Reference Laboratory (NTRL). To support the Uganda NTRL, the partnership is using Global Positioning System/Global Information System (GPS/GIS) technology to map multiple laboratory sites for development of a transportation network and to monitor specific improvements in the identified laboratories. According to John Nkengasong, Chief of the CDC's Division of Global HIV/AIDS International Laboratory Branch, and Co-chair of the PEPFAR Laboratory Technical Working group, “The PEPFAR-BD partnership has taken a lead in Uganda to strengthen laboratory systems in developing quality management and specimen transport referral systems, which will go a long way to improve patient management and outcomes.”

In Mozambique, where BD has already supported phlebotomy training, a 2009 workplan is being developed under which BD will work with CDC, the Mozambique Ministry of Health, the American Society for Clinical Pathology (ASCP), and others to support laboratory quality management training, assist in the implementation of the national laboratory quality plan, and support an external quality assessment (EQA) program. In both Mozambique and Uganda, CDC’s field staff provides a significant amount of support to create a functional partnership.