LABORATORY SERVICES IN THE CARIBBEAN – ESSENTIAL BUT SILENT PARTNER? Valerie Wilson Caribbean Med Labs Foundation LAC Forum Haiti 7 November 2017
HIV Treatment and Care 90-90-90 targets require adequate LABORATORY support HIV Testing CD4, VL, Chem, Haem Viral load EMTCT Targets require access to testing services TB elimination requires laboratory testing and reference services
Role of Laboratory Services in meeting 90-90-90 targets Testing is the Uirst point of access to the continuum of care and is central and critical to the achievement of each of the 90-90-90 targets Laboratory services underpin all aspects: Identifying individuals infected with HIV (=irst 90) CD4 testing – to determine level on initiation of treatment (second 90) Identifying viral suppression through monitoring VL (third 90) Identifying opportunistic infections such as TB, and sexually transmitted infections to ensure appropriate interventions. Monitoring safety of patients on treatment - biochemistry and haematology Identifying drug resistance in treatment failures (third 90)
$9 Million HIV Error September 2014 Caribbean Government pays big for wrong diagnosis The Government has agreed to compensate a woman with just under $9 million for a misdiagnosis that she was HIV- positive. But that is not enough for the 28- year-old, who suspects that medication she was treated with 2005 POSITIVE. SECOND TEST 2007 – nine years ago might have affected her baby NEGATIVE. PAIN, LOSS OF RELATIONSHIP
Government Lab in the Caribbean mistakenly declared eight mothers HIV positive - Treatment initiated (2015)
Transmission of HIV - Blood Transfusion - 2017 6
Lab Error affects EVERYONE! Regional data on laboratory pro=iciency in 2014: For Glucose (blood sugar) testing: 30-51% UNACCEPTABLE results! For Cholesterol testing: 15-54% UNACCEPTABLE results! For Creatinine (kidney function) testing: 47-49% UNACCEPTABLE results!
Gaps in Laboratory Services 2014-2017 Examples: CD4 counts in more than one country > 1 year Viral Load in more than 3 countries – 1-2 years HIV Con=irmatory Testing in one country – 2 years Chemistry and Haematology > 1 year 8
LAB BUSINESS IS EVERYBODY’s BUSINESS FOCUS ON TREATMENT/MEDICATION: Decisions to provide medication/treatment and monitoring of progress of patients on medication depend on laboratory services 9
Major improvements in laboratory services to meet 90-90-90 targets Access to quality HIV testing services by key populations Adoption of National Laboratory Policies (developed under GF R9) to ensure co-ordination, quality monitoring and access to testing services Adaptation and adoption of model legislation to support policy implementation Dedicated budgets to ensure sustainability of laboratory services in light of changes in donor priorities Negotiated bulk pricing for reagents and supplies Improved procurement and maintenance services to reduce stock-outs and equipment downtime Trained human resources – adequate expertise at all levels
WE MUST ALL BE ADVOCATES
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