Building Integrated Testing Programs for Infectious Diseases.

In the past 2 decades, testing services for diseases such as human immunodeficiency virus (HIV), tuberculosis, and malaria have expanded dramatically. Investments in testing capacity and supportive health systems have often been disease specific, resulting in siloed testing programs with suboptimal capacity, reduced efficiency, and limited ability to introduce additional tests or respond to new outbreaks. Emergency demand for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing overcame these silos and demonstrated the feasibility of integrated testing. Moving forward, an integrated public laboratory infrastructure that services multiple diseases, including SARS-CoV-2, influenza, HIV, tuberculosis, hepatitis, malaria, sexually transmitted diseases, and other infections, will help improve universal healthcare delivery and pandemic preparedness. However, integrated testing faces many barriers including poorly aligned health systems, funding, and policies. Strategies to overcome these include greater implementation of policies that support multidisease testing and treatment systems, diagnostic network optimization, bundled test procurement, and more rapid spread of innovation and best practices across disease programs.

Building and Sustaining Optimized Diagnostic Networks to Scale-up HIV Viral Load and Early Infant Diagnosis.

BACKGROUND: Progress toward meeting the UNAIDS 2014 HIV treatment (90-90-90) targets has been slow in some countries because of gaps in access to HIV diagnostic tests. Emerging point-of-care (POC) molecular diagnostic technologies for HIV viral load (VL) and early infant diagnosis (EID) may help reduce diagnostic gaps. However, these technologies need to be implemented in a complementary and strategic manner with laboratory-based instruments to ensure optimization. METHOD: Between May 2019 and February 2020, a systemic literature search was conducted in PubMed, the Cochrane Library, MEDLINE, conference abstracts, and other sources such as Unitaid, UNAIDS, WHO, and UNICEF websites to determine factors that would affect VL and EID scale-up. Data relevant to the search themes were reviewed for accuracy and were included. RESULTS: Collaborations among countries, implementing partners, and donors have identified a set of framework for the effective use of both POC-based and laboratory-based technologies in large-scale VL and EID testing programs. These frameworks include (1) updated testing policies on the operational utility of POC and laboratory-based technologies, (2) expanded integrated testing using multidisease diagnostic platforms, (3) laboratory network mapping, (4) use of more efficient procurement and supply chain approaches such as all-inclusive pricing and reagent rental, and (5) addressing systemic issues such as test turnaround time, sample referral, data management, and quality systems. CONCLUSIONS: Achieving and sustaining optimal VL and EID scale-up within tiered diagnostic networks would require better coordination among the ministries of health of countries, donors, implementing partners, diagnostic manufacturers, and strong national laboratory and clinical technical working groups.

Tuberculosis, injecting drug use and integrated HIV-TB care: a review of the literature.

BACKGROUND: People who inject drugs (PWID) are at increased risk of tuberculosis (TB) and reduced retention in treatment. There is a need to document strategies for integrated delivery of HIV, TB and drug dependency care. METHODS: This article reviews the literature on rates of TB mono- and co-infection, and published and grey literature descriptions of TB and HIV-TB care, among PWID. RESULTS: Latent TB infection prevalence was high and active disease more common among HIV-positive PWID. Data on multidrug-resistant TB and co-infections among PWID were scarce. Models of TB care fell into six categories: screening and prevention within HIV-risk studies; prevention at TB clinics; screening and prevention within needle-and-syringe-exchange (NSP) and drug treatment programmes; pharmacy-based TB treatment; TB service-led care with harm reduction/drug treatment programmes; and TB treatment within drug treatment programmes. Co-location with NSP and opioid substitution therapy (OST), combined with incentives, consistently improved screening and prevention uptake. Small-scale combined TB treatment and OST achieved good adherence in diverse settings. Successful interventions involved collaboration across services; a client-centred approach; and provision of social care. No peer-reviewed studies described models of integrated HIV-TB care for PWID but grey literature highlighted key components: co-located services, provision of drug treatment, multidisciplinary staff training; and remaining barriers: staffing inefficiencies, inadequate funding, police interference, and limited OST availability. CONCLUSIONS: Integration with drug treatment improves PWID engagement in TB services but there is a need to document approaches to HIV-TB care, improve surveillance of TB and co-infections among PWID, and advocate for improved OST availability.

Обзорная оценка Национальной программы по туберкулезу в Республике Молдова: 4–15 февраля 2013 года

Республика Молдова входит в число 18 приоритетных стран для борьбы с туберкулезом (ТБ) в Европейском регионе ВОЗ и 27 стран мира с высоким бременем ТБ с множественной лекарственной устойчивостью (МЛУ-ТБ). Согласно классификации Глобального фонда для борьбы со СПИДом, туберкулезом и малярией, Республика Молдова занимает второе место среди 110 стран по уровню средств, выделяемых на душу населения. Вторая фаза реализации консолидированного гранта в рамках раундов 8 и 9 была одобрена в декабре 2012 года с условием представления на следующем этапе обзорной оценки Национальной программы по туберкулезу и стратегического плана (на основе этой обзорной оценки) по усилению приверженности лечению и снижению числа пациентов, результаты лечения которых неизвестны. Серьезную озабоченность вызывал тот факт, что, как показала оценка, осуществление мер вмешательства и поддержка оказали лишь ограниченное воздействие на улучшение результатов лечения. В октябре 2012 года Министерство здравоохранения обратилось в Европейское региональное бюро ВОЗ с просьбой обеспечить координацию обзорной оценки Национальной программы по туберкулезу.

Review of the National Tuberculosis Programme in the Republic of Moldova: 4–15 February 2013

The Republic of Moldova is among the WHO European Region’s 18 high-priority countries for tuberculosis (TB) control and among the world’s 27 high multidrug-resistant TB (MDR-TB) burden countries. The Global Fund to Fight AIDS, Tuberculosis and Malaria ranks the Republic of Moldova second among 110 countries by level of funds provided per capita. The second phase of implementation of its consolidated Round 8 and 9 TB grant was approved in December 2012 with a request to submit, at a later stage, a review of the National TB Programme and a strategic plan (based on the review) to improve treatment compliance and reduce loss to treatment follow up. A major concern highlighted was that supported interventions have shown only a limited impact in improving treatment success. In October 2012 the Ministry of Health asked the WHO Regional Office for Europe to coordinate the review of the National TB Programme.The review took place from 4 to 15 February 2013. Twelve international and seven national experts participated, visiting 18 districts and three municipalities, the autonomous region of Gagauzia and the Transnistria region. The review team developed a strategic plan to improve treatment compliance and reduce loss to treatment follow up immediately after the review; this appears as part of the roadmap attached to this report (Annex 1). The team members conveyed their key findings and recommendations at the end of the mission to the Minister of Health.