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

• 批准号: 9765909
• 负责人: David Wesley Dowdy
• 金额: $ 69.88万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 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/9765909
• 关键词: Address; Africa; Africa South of the Sahara; African; Agreement; Algorithms; Antibiotics; Bacterial Meningitis; Biological Assay; Budgets; 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 virus; 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; Reporting; Research; Resources; Review Literature; Sampling; Security; Serologic tests; Specimen; Strategic Planning; Syndrome; System; Testing; Time; Training; Transportation; Uncertainty; Viral hepatitis; Yellow Fever; base; burden of illness; communicable disease diagnosis; cost; cost effective; cost effectiveness; design; diagnostic assay; 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; response; tool; virology; years of life lost

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).

项目摘要 尽管最近进步，传染病仍然占撒哈拉以南非洲丧生的Yeaars的50％。 这项国际协议一直是控制这种流行病的关键障碍 地方性健康负担一直是实验室网络的次优设计。 议程（GHSA）要求国家建立一个分层的自然实验室系统，并“确定 诊断能力实用，并且需要在公共等级的每个级别上”。 在较低的实验室进行测试可以改善转机时间，并可以利用更简单的测定，但增加了成本和成本和 相比之下，可以牺牲质量。 运输患者样品，随之而来的延误和损失进行跟进。 诊断资源并不明显，决策者必须为多种病原体和 可用的测定法以建立国家实验室战略计划的侵犯基础。 支撑研究的总体目标是理想地放置诊断测试，用于高高高高高高高高高高高高高高高高高高高中。 在资源有限的国家中，优先的感染性疾病以加纳为例 目的，我们将表征诊断关键感染性的实施，有效性和效率 加纳公共卫生实验室内的不同层次和地理/流行病学环境的疾病 网络。我们选择了三种流行病的混合 和无量的）和三种公共卫生重要性疾病（DPHIS：HIV，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的最佳性能 信封）基于实验室的诊断测试水平 通过开发详细的基于代理的详细套件，疾病进展，测定可用性和分层系统 仿真模型。 模型是多种条件与不同诊断测试算法的集成，而不是集中 仅在AIM 1中的单个疾病系统上，我们将收集有关实验室特征的经验数据（例如 远程度，测试可用性，测试延迟，快递性能，成本），诊断有效（估计） 既准确又及时的诊断比例）和诊断功效（例如，单位成本和成本 根据准确/及时的诊断）。 加纳的公共卫生实验室网络。 估计Prictionality Epd-Dphis的相关疾病特异性结果的模拟模型（例如，数字，数字。 及时的艺术启动和不必要的抗生素处方的艾滋病毒阳性婴儿避免了脑膜炎）。