Approximately 1,500 laboratory professionals, clinicians, programme managers, epidemiologists, researchers, students, and policy makers from around the world convened in Cape Town, South Africa from December 1-7, 2012 for the first International Conference of the African Society for Laboratory Medicine (ASLM).
Under the theme “Accurate Laboratory Diagnostics – A Pillar of Quality Health Care,” healthcare professionals and policy makers presented and discussed the latest developments and initiatives for strengthening national laboratory health systems and networks, diagnostics, and their impact on healthcare delivery and disease surveillance. ASLM is the first dedicated, laboratory professional development umbrella organisation to guide laboratory medicine on the continent.
“Laboratory services play a pivotal role in maintaining healthy communities,” said ASLM CEO Dr. Tsehaynesh Messele. “Healthy communities rely on knowledge to address disease diagnosis, outbreaks, research and development. Participants will engage in robust discussion and debate on key diagnostic issues affecting the delivery of healthcare in Africa, which in turn will help strengthen the laboratory medicine profession across the continent.”
The conference addressed a wide range of laboratory-related subject areas with particular emphasis on:
• Translation of laboratory knowledge, practices, and technologies into clinical care;
• Game-changing point-of-care technologies (POCT) for conducting complex lab tests in decentralised facilities;
• Steps to remedy the critical lab worker shortages;
• Establishment of regional centres of excellence; and
• Laboratory investigations and evidence-based effectiveness in real world settings.
This conference brought attention to a new strategic vision of ASLM called ‘ASLM2020,’ in which it is aimed to meet various targets by the year 2020, according to Conference Chair Trevor Peter. “These targets include the certification of 30,000 laboratory staff, the harmonisation in the regulation of diagnostics in Africa’s five economic regions, the international accreditation of 250 laboratories, and the strengthening of an African Network of National Public Health Reference laboratories in 30 countries.”
Speakers and attendees included Ministers of Health from eight countries, senior scientists from South Africa’s National Health Laboratory Service (NHLS) and other countries, Dr. Asha-Rose Migiro, the United Nations Secretary General's Special Envoy for AIDS in Africa, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).
“In Africa, less than 10 percent of clinical decisions are based on laboratory results, compared to 70 percent in the United States,” said ASLM Board of Directors’ former Chair John Nkengasong, who also serves as the Associate Director for Laboratory Science and Chief of the International Laboratory Branch for the CDC’s Division of Global HIV/AIDS. “Laboratory accreditation is critical for ensuring the quality of those results and fostering improvement in other sectors of the health care system. Laboratory data are key for surveillance purposes and policy decision making,” he added.
Highlighted below are nine abstracts of particular interest:
How critical are electronic medical record systems for African patients on antiretroviral treatment (ART)?
They can be very critical, researchers have learned. An increasing number of patients are being put on ART. The longer patients stay on ART, the higher their chances of becoming resistant to drugs, which can pose serious challenges in reducing HIV spread and burden. This session described how the effective use of an electronic medical record system was critical in supplying patient-focused information to clinicians, patients, lab staff and programme management. This tool has also been modified to identify patients that need to be tested for drug resistance.
What are POCT? Why do they matter?
POCT enable quicker test results, closer to the community. This allows patients to begin ART on the same day results are known. Trained nurses in Themba Lethu clinic, Johannesburg, South Africa, implemented this technology. Researchers share important experiences and challenges of using this strategy for clinical management of HIV patients. These experiences are valuable as many countries and facilities are considering adding POCT through non-lab clinical staff.
Can mobile labs be a solution in remote areas of Africa?
Researchers are cautiously optimistic. This paper presented the experience of using mobile microbiology labs in Burkina Faso and Cote d’Ivoire since 2003 where multiple outbreaks were effectively diagnosed and resolved using this strategy. Several administrative and human resource challenges were also discussed. Lab diagnosis is essential early on in outbreaks to launch an effective response, but is challenging in remote areas of Africa.
How has the quality of patient care been improved in Africa?
By establishing a network of accurate and precise lab services across a large, resource-poor area and using a complex but needed test, a report shows viral load (VL) monitoring is an increasingly valuable strategy for clinical care of HIV patients but is expensive and complex to conduct and it’s not readily available, especially in remote settings. VL testing began in five labs in Nigeria in 2004. In 2011, the number grew to 10 labs, with more than 55,000 tests conducted.
Can saliva be a cheaper, less invasive and accurate method for malaria diagnosis in Africa?
It may be, according to a comparative study. Detecting the malaria parasite requires drawing blood which increases the risk of accidental needlestick-related infections and is poorly accepted by communities with blood taboos and mothers with anaemic children. This is the first report on the utility of saliva as a viable option in malaria diagnostics. The two methods were compared in 30 children and saliva provided superior results.
How can access to diagnostics and HIV treatment be increased to reach goal of 15 million people on ART by 2015?
By developing and deploying simplified and reliable lab technologies that can be used closer to the community, better known as Point-of-Care Technologies (POCT). In this session, the World Health Organization shared guidance to countries and manufacturers on how to make best use of existing technologies and new development priorities.
Why it’s important for clinical labs in Africa to be accredited?
Because they are the backbone of health systems, especially in sub-Saharan Africa, which faces severe disease and health system challenges. Lab quality is assessed using internationally accepted standards (CLIA or ISO 15189). Authors presented a benchmark study of sub-Saharan labs that demonstrates quality gaps, disparities across countries and provided a future template for strengthening lab and health systems.
What’s the impact in Africa of a TB test that can be done in two hours?
Very positive, scientists report. The WHO-recommended Xpert MTB/RIF is a simplified diagnostic test for TB and multidrug-resistant (MDR) type of TB that gives results in two hours (vs. several weeks for the traditional sputum culture and sensitivity test). This testing strategy for earlier detection and treatment and increased diagnosis of TB and MDR TB was rolled out worldwide in seven countries. This session described the positive outcomes. TB is the commonest cause of death and disability in HIV-infected people and is difficult to diagnose.
How can sub-Saharan countries meet their critical shortage of laboratory workers?
A review of 194 national and 135 donor agency source documents from 42 sub-Saharan Africa countries sheds some light on this neglected area. The first of its kind and of this magnitude, the study showed critical shortages of laboratory workers, plans and policies to support them systemically, and minimal coordination of plans across donors and national governments. The study could serve as a useful baseline to address this high priority issue for ministers of health across the continent.