Fonjungo Peter N, Alemnji George A, Kebede Yenew, Opio Alex, Mwangi Christina, Spira Thomas J, Beard R Suzanne, Nkengasong John N
International Laboratory Branch, Division of Global HIV and Tuberculosis (DGHT), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
DGHT, CDC, Caribbean Regional Office, Bridgetown, Barbados.
Clin Infect Dis. 2017 Mar 15;64(6):796-803. doi: 10.1093/cid/ciw817.
The recent Ebola virus outbreak in West Africa clearly demonstrated the critical role of laboratory systems and networks in responding to epidemics. Because of the huge challenges in establishing functional laboratories at all tiers of health systems in developing countries, strengthening specimen referral networks is critical. In this review article, we propose a platform strategy for developing specimen referral networks based on 2 models: centralized and decentralized laboratory specimen referral networks. These models have been shown to be effective in patient management in programs in resource-limited settings. Both models lead to reduced turnaround time and retain flexibility for integrating different specimen types. In Haiti, decentralized specimen referral systems resulted in a 182% increase in patients enrolling in human immunodeficiency virus treatment programs within 6 months. In Uganda, cost savings of up to 62% were observed with a centralized model. A platform strategy will create a network effect that will benefit multiple disease programs.
近期西非爆发的埃博拉病毒疫情清楚地表明了实验室系统和网络在应对疫情方面的关键作用。由于在发展中国家各级卫生系统中建立功能完备的实验室面临巨大挑战，加强样本转诊网络至关重要。在这篇综述文章中，我们基于两种模式提出了一个用于发展样本转诊网络的平台策略：集中式和分散式实验室样本转诊网络。这些模式已被证明在资源有限环境下的项目患者管理中是有效的。两种模式都能缩短周转时间，并保持整合不同样本类型的灵活性。在海地，分散式样本转诊系统使参与人类免疫缺陷病毒治疗项目的患者在6个月内增加了182%。在乌干达，采用集中式模式观察到成本节约高达62%。一个平台策略将创造一种网络效应，使多个疾病项目受益。
