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

了解和提高加纳传染病公共卫生实验室网络的有效性

基本信息

批准号：
10359747
负责人：
David Wesley Dowdy
金额：
$ 66.63万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-11 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10359747
关键词：
Address Africa Africa South of the Sahara African Agreement Algorithms Antibiotics Bacterial Meningitis Biological Assay Characteristics Clinical Communicable Diseases Communication Country Coupled Custom Data Data Collection Decision Aid Decision Making Detection Diagnosis Diagnostic Diagnostic tests Disease Disease Outbreaks Disease Progression Ebola Effectiveness Emergency Situation Endemic Diseases Ensure Epidemic Epidemiology Exercise Future Geography Ghana Goals HIV HIV Seropositivity HIV diagnosis HIV/HCV HIV/TB Health Health system Healthcare Systems Hepatitis C Hepatitis C virus Human Resources Immunization Immunoglobulin M Incidence Infant Infection Infrastructure International Intervention Laboratories Measles Meningitis Methods Modeling Nucleic Acid Amplification Tests Outcome Patients Pattern Performance Peripheral Population Process Public Health Rapid diagnostics Reporting Research Resources Review Literature Sampling Security Serology Specimen Strategic Planning Syndrome System Testing Time Training Transportation Uncertainty Viral hepatitis Yellow Fever base budget impact burden of illness communicable disease diagnosis cost cost effective cost effectiveness data-driven model design diagnostic assay diagnostic strategy diagnostic value disease natural history effectiveness measure experience follow-up global health improved indexing innovation low and middle-income countries low income country mathematical model models and simulation pandemic disease pathogen rapid testing remote grading response tool years of life lost

项目摘要

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).

项目概要尽管最近取得了进展，但撒哈拉以南非洲地区 50% 的寿命损失仍由传染病造成。国际社会越来越多地一致认为，控制这一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设计不理想造成的。议程（GHSA）要求各国建立分级国家实验室体系并“确定实验室的水平” 从国家到地区的公共卫生层级的每个级别都具有实用且需要的诊断能力。” 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检测方法，但会增加成本和相比之下，在更高级别的实验室进行测试可以确保更好的质量，但需要更高的质量。运输患者样本，从而导致后续延误和损失。诊断资源并不明显，决策者必须权衡多种病原体的多种因素和可用的分析方法为国家实验室战略计划建立合理的基础。拟议研究的总体目标是确定诊断测试的理想位置资源有限国家的重点传染病，以加纳为例实现这一目标。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级别和地理/流行病学环境的疾病我们选择了三种易流行疾病（EPD：细菌性脑膜炎、黄热病）。以及三种具有公共卫生重要性的疾病（DPHI：艾滋病毒、结核病和丙型肝炎病毒）。我们将寻求确定最佳方案（即在给定的承受能力范围内最有效和最具成本效益的方案）这 6 种主要传染病的实验室诊断检测水平与通过开发一套详细的基于代理的试剂盒来了解疾病进展、检测可用性和分层系统由于实验室网络必须适用于所有传染病，这是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，而不是集中仅针对单一疾病系统在目标 1 中，我们将收集有关实验室特征的经验数据（例如，等级、远程性、测试可用性、测试延迟、快递性能、成本）、诊断有效性（估计准确且及时的诊断比例）以及诊断效率（例如单位成本和成本）根据准确/及时的诊断），这将能够表征当前的能力和有效性。在目标 2 中，我们将开发并整合一套精简的加纳公共卫生实验室网络。模拟模型，估计这些优先 EPD-DPHI 的相关疾病特定结果（例如，数量 HIV 阳性婴儿及时开始 ART 治疗并避免不必要的脑膜炎抗生素处方）。