Shifting the Caribbean’s Laboratory Landscape One Accreditation at a Time

Laboratories are crucial to any country’s health system – critical for screening, diagnose, and monitoring diseases like HIV and TB. Since the U.S. Centers for Disease Control and Prevention (CDC) began work in the Caribbean, strengthening laboratories has been a priority.

In 2009, when the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) initiated work in the region, no accredited government-owned clinical laboratories existed. Services such as rapid HIV testing and molecular testing for HIV/AIDS treatment and monitoring were not widely available. Since these services were not available locally, samples had to be shipped out of the Caribbean at great expense to the Ministries of Health.

The CDC, in partnership with PEPFAR, began providing technical assistance to labs across the region to strengthen these direly needed services. This ultimately led to the accreditation of ten government-owned clinical laboratories, which are still operational in the Bahamas, Jamaica, Barbados, Trinidad and Tobago, and Suriname. These labs have also expanded their testing capabilities to include surveillance of other infectious diseases.

Shifting the Paradigm

In 2011, the Caribbean was second to sub–Saharan Africa in HIV/AIDS burden, with numbers continuing to rise. Infrastructure improvements, including laboratory services, were neglected. This exacerbated challenges in the health landscape.

With the backing of PEPFAR, the CDC Caribbean Regional Office embarked on a mission to transform the perception of laboratory work. The goal was to place the patient at the heart of the work, demonstrating that improved diagnostics and accreditation would have a ripple effect, enhancing the delivery of life-saving interventions and services

Innovation and Accreditation

Tangible achievements in laboratory strengthening remained an uphill battle as there were varying needs across the region. However, the team was able to tailor CDC and PEPFAR strategies based on lessons learned from successful interventions in Africa, building off ideas and innovations to create a program for smaller lab spaces with limited resources. Two successful initiatives were geared at training dedicated lab mentors and delivering the Strengthening Lab Management toward Accreditation Training program (SLMTA). Over the past decade, over twenty regional labs have participated in the program.

The dedication to improved laboratory services resulted in investments in laboratory infrastructure, establishment of new testing platforms, decentralization of services, and implementation of technology solutions for real-time data management in the region. Through these efforts, ten public sector labs achieved accreditation; the first in the Bahamas in 2013 and the most recent in Trinidad in 2023.

“This is the time of growth in our laboratory sector,” said the Assistant Programme Director of the HIV/AIDS Coordinating Unit in Trinidad and Tobago, Dr. Ayanna Sebro. Adding, “The presence of CDC as one of our laboratory partners has been invaluable with respect to technical advice on testing methodologies, support for the laboratory professionals, and laboratory system review.”

Building on Successes

Today, CDC continues to work with labs across the region to build capacity and ensure the Caribbean has strong public health infrastructure to support ongoing disease management while meeting the needs for emerging infections. Each country that received tailored support for lab capacity continues to see profound improvements in their clients’ healthcare experiences. The overall progress includes:

  • expanding quality assurance programs for HIV testing by 100%,
  • improving the quality of patient samples collected, resulting in rejection rates of less than 5%,
  • expanding electronic lab information systems, resulting in 75% less paper-based reporting, and
  • supporting capacity building for over 5,000 technical lab staff across the region.
Caption: Queen Elizabeth Hospital Laboratory Accreditation. From L-R: Giselle Guevara (CDC, Barbados), Denise Beckles, Sharonmae Shirley, Dr. Joy St. John

System-strengthening investments, like accreditation, can be challenging because they require a shift in mindset and to change the status quo. However, these efforts are key to ensuring sustainability.

Below, lab administrators share their firsthand experiences with the process of accreditation and offer lessons learned to others:

“In one word, teamwork. It was extremely important to have all staff understand the accreditation process and its importance, and to have all staff participate in the process and be motivated by it. We also had a great deal of support and encouragement from Ministry officials, which was truly indispensable. The SLMTA mentors were also absolutely pivotal to providing and conveying experience and know-how to both management and staff.”  – Lab Manager Dr. Indira Martin at the Bahamas National Reference Lab accredited in 2013.

 Changing the mindset of the laboratory staff and the attitudes of the other hospital departments whose services were an integral part of the accreditation process.” –Quality Manager Denise Beckles at The Queen Elizabeth Hospital Lab in Barbados accredited in 2016.

Caption: From L-R: Annabelle Sherwood, Ilene Wright, Dr. Angela Scott, Mitchelle Maylor-Archat, Andrea Orelue, Quality Assurance Coordinator -2016

“We sought to develop the “perfect” procedure/process/form before implementing it. More emphasis was placed on reviewing and revising documents rather than implementing them. It would have been more efficient to develop, implement, review, and then revise.”—Quality Manager Lisa Edghill at CARPHA in Trinidad, accredited in 2018.

Foster esprit de corps [foster a spirit of unity] where everyone shares the same drive to achieve accreditation. Constantly remind the team that so-called “mistakes” are not the end of the world but a means to continually improve.” – Quality Assurance Coordinator Andrea Orelue from National Public Health Lab in Jamaica accredited in 2016.

CDC continues to play an integral role in the Caribbean, as accredited labs also serve as referral labs for other countries with less capacity. By supporting others in the region, accredited labs ensure patients receive reliable and accurate results—a critical component in ending the HIV and TB epidemics.