Understanding and Improving the Effectiveness of Public Health Laboratory Networks for Infectious Diseases in Ghana

项目摘要 尽管最近取得了进展，但传染病仍然占撒哈拉以南非洲地区寿命损失的50%。 越来越多的国际社会一致认为，控制这一流行病的一个关键障碍， 地方病健康负担一直是实验室网络的次优设计。全球卫生安全 GHSA要求各国建立一个分级的国家实验室系统，并“确定 从国家到地区的各级公共卫生机构都需要实用的诊断能力。 在较低级别的实验室进行测试可以缩短周转时间，并且可以利用更简单的测定，但会增加成本和 可能会牺牲质量。相比之下，在更高级别的实验室进行测试可能会确保更好的质量，但需要 运送患者样本，伴随着后续的延迟和损失。的优化配置 诊断资源并不明显，决策者必须权衡多种病原体的许多因素， 现有的检测方法，以建立国家实验室战略计划的合理基础。 拟议研究的总体目标是确定诊断测试的理想位置， 以加纳为例，在资源有限的国家，为了实现这一 目标，我们将描述诊断关键传染病的实施，有效性和效率， 加纳公共卫生实验室内不同层次和地理/流行病学背景下的疾病 网络我们选择了三种易患脑膜炎的疾病（EPD：细菌性脑膜炎、黄热病 和麻疹）和三种对公共卫生具有重要意义的疾病（DPHIs：艾滋病毒、结核病和丙型肝炎病毒）。 我们将寻求确定最佳（即，最有效和最具成本效益，在一定的负担能力范围内 这6种主要传染病的实验室诊断检测水平， 疾病进展、检测可用性和分层系统， 仿真模型由于实验室网络必须对所有传染病发挥作用， 模型是多个条件与不同诊断测试算法的集成，而不是集中 只在一个单一的疾病系统上。在目标1中，我们将收集实验室特征的经验数据（例如，层， 偏远性、测试可用性、测试延迟、快递绩效、成本）、诊断有效性（估计 既准确又及时的诊断比例），和诊断效率（例如，单位成本和成本 准确/及时的诊断）。这将有助于确定联合国系统目前的能力和效力， 加纳公共卫生实验室网络。在目标2中，我们将制定和整合一套精简的 估计这些优先EPD-DPHI的相关疾病特异性结果的模拟模型（例如，number 及时开始抗逆转录病毒疗法和避免不必要的脑膜炎抗生素处方的艾滋病毒阳性婴儿）。

Project Summary Despite recent advances, infectious diseases still account for 50% of years of life lost in sub-Saharan Africa. There has been growing international agreement that a critical roadblock to controlling this epidemic and endemic health burden has been the suboptimal design of laboratory networks. The Global Health Security Agenda (GHSA) requires countries to establish a tiered national laboratory system and “determine the level of diagnostic capability practical and needed at each level of the public health hierarchy from national to district.” Testing at lower tier laboratories improves turn-around time and can utilize simpler assays but adds costs and may sacrifice quality. By contrast, testing at higher tier laboratories may ensure better quality but requires transporting patient samples, with attendant delays and losses to follow-up. The optimal allocation of diagnostic resources is not obvious and decision makers must weigh many factors for multiple pathogens and available assays to establish a rational basis of a National Laboratory Strategic Plan. The overall objective of the proposed research is to identify the ideal placement of diagnostic testing for high priority infectious diseases in resource-limited countries, using Ghana as an example. To accomplish this objective, we will characterize the implementation, effectiveness, and efficiency of diagnosing key infectious diseases at different tiers and geographic/epidemiological settings within the Ghanaian public health laboratory network. We have selected a mix of three epidemic-prone diseases (EPDs: bacterial meningitis, yellow fever and measles) and three diseases of public health importance (DPHIs: HIV, tuberculosis and hepatitis C virus). We will seek to identify the optimal (i.e., most effective and most cost-effective, within a given affordability envelope) level of laboratory-based diagnostic testing for these 6 key infectious diseases as a function of disease progression, assay availability, and tiered system by developing a detailed suite of agent-based simulation models. As laboratory networks must function for all infectious diseases, a key innovation of our model is the integration of multiple conditions with different diagnostic testing algorithms, rather than focusing only on a single disease system. In Aim 1, we will collect empirical data on laboratory characteristics (e.g., tier, remoteness, test availability, testing delays, courier performance, costs), diagnostic effectiveness (estimated proportion of diagnoses that are both accurate and timely), and diagnostic efficiency (e.g., unit cost and cost per accurate/timely diagnosis). This will enable characterization of the current capacity and effectiveness of Ghana's public health laboratory network. In Aim 2, we will develop and integrate a streamlined set of simulation models that estimate relevant disease-specific outcomes for these priority EPD-DPHIs (e.g., number HIV-positive infants with timely ART initiation and unnecessary antibiotic prescriptions for meningitis averted).