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，但在撒哈拉以南非洲，传染病仍占寿命损失年数的50%。 越来越多的国际社会一致认为，控制这种流行病的一个关键障碍是 地方性健康负担一直是实验室网络的次优设计。全球卫生安全 议程“(GHSA)要求各国建立分级国家实验室系统，并”确定 在从国家到地区的公共卫生等级的每个级别上，诊断能力都是可行的和所需的。 在较低级别的实验室进行测试可以缩短周转时间，并可以利用更简单的分析方法，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 运送病人样本，随之而来的延误和随之而来的随访损失。资源的最优配置 诊断资源不明显，决策者必须权衡多个病原体和 建立国家实验室战略计划的合理基础的可用分析方法。 拟议研究的总体目标是确定HIGH诊断测试的理想位置 资源有限国家的优先传染病，以加纳为例。要做到这一点 目的，我们将表征重大传染病诊断的实施情况、效果和效率 加纳公共卫生实验室内不同级别和地理/流行病学环境下的疾病 网络。我们选择了三种易流行疾病(EPD：细菌性脑膜炎、黄热病 三种对公共卫生具有重要意义的疾病(登革热：艾滋病毒、结核病和丙型肝炎)。 我们将努力在给定的负担能力范围内确定最佳的(即最有效和最具成本效益的) 信封)这6种主要传染病的实验室诊断检测水平 通过开发一套详细的基于代理的套件，实现疾病进展、检测可用性和分级系统 模拟模型。由于实验室网络必须为所有传染病发挥作用，我们的一项关键创新 模型是多种条件与不同诊断测试算法的集成，而不是专注于 只存在于单一疾病系统中。在目标1中，我们将收集关于实验室特征的经验数据(例如，层、 远程、测试可用性、测试延迟、信使性能、成本)、诊断效果(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 根据准确/及时的诊断)。这将使人们能够表征目前的能力和有效性 加纳的公共卫生实验室网络。在目标2中，我们将开发和集成一套简化的 估计这些优先EPD-DPHI的相关疾病特定结果的模拟模型(例如，数量 艾滋病毒阳性婴儿及时开始抗逆转录病毒治疗，避免了不必要的脑膜炎抗生素处方)。

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).