Strengthening Laboratory Capacity
Strengthening Laboratory Capacity: A strong national public health laboratory system is fundamental to health security and safety. CDC partners with the National Public Health Laboratory (LNSP) to strengthen national and departmental capacity to test for pathogens like cholera, malaria, rabies, HIV, and TB.
- (National) Specimen Referral Network: CDC has supported the establishment, expansion, and optimization of a Specimen Referral Network (SRN) since 2011. In 2016, CDC facilitated the consolidation and modification of an existing SRN to accommodate the centralized scale-up of HIV viral load (VL) testing. Once the VL SRN was fully functional, CDC saw an opportunity to support the Haitian Ministry of Health (MOH) to consolidate the VL SRN and an existing early infant diagnosis (EID) SRN. The resulting consolidated National SRN (NSRN) was relaunched in 2018 and increases efficiency, improves specimen transport and results reporting, and promotes government ownership and sustainability. The NSRN combines centralized specimen transport for EID, VL, and disease surveillance; semi-centralized specimen transport for TB diagnosis and MDR-TB detections; and decentralized specimen transport for national quality assurance programs. The NSRN covers 208 sites and facilitates the transport, tracking, and monitoring of specimen quality, quantities, and testing results. This system is also used for national proficiency testing (PT) programs for distributing PT panels and reporting. LNSP, with support from the CDC Haiti Laboratory team, trained 450 participants throughout the country on biosafety, specimen packing, shipment and an electronic tracking system in early 2018. Additionally, CDC supported the development of a tablet-based electronic tracking system which allows real-time monitoring of the NSRN and identification of issues as they occur.
- Tuberculosis (TB): CDC has worked closely with the MOH to build TB-related laboratory and clinical capacity at key sites. Laboratory diagnostic capacity for TB has expanded from no site with fluorescent microscopy and one site with nucleic acid amplification equipment in 2010 to 52 sites with fluorescent microscopy and 25 sites with nucleic acid amplification capacity in 2017. This has contributed to improved detection and notification of cases of active TB — the World Health Organization estimates that the case detection rate of active tuberculosis cases in Haiti improved from 62% in 2010 to over 80% in 2017. In 2017, the MOH celebrated the opening of a national biosafety level 3 (BSL-3) laboratory for multidrug-resistant (MDR-TB) diagnosis and treatment. CDC supported the establishment of the laboratory which will greatly augment Haiti’s capacity to detect and treat TB and MDR-TB and support critical research into the evolution of TB drug resistance in Haiti.
- Strengthening Laboratory Information Systems:. CDC supports and works closely with LNSP and GHESKIO to establish and optimize laboratory information systems to improve public health service quality and efficiencies. The LNSP and GHESKIO laboratory information systems have the capabilities to interface with major testing instruments used for viral load and early infant diagnosis testing. The testing results are directly returned to the patient service sites after validation. These capabilities have improved the service quality by limiting transcription errors and real-time reporting of quality-assured testing results. The electronic reporting system has greatly improved CDC’s capacity to monitor implementing partner performance on key indicators of laboratory services and provide real-time feedback on a monthly basis on HIV viral load monitoring. Additionally, CDC is collaborating with implementing partners to ensure the connectivity of the electronic medical record (EMR) system with the laboratory information systems.