Improving Health Outcomes through Stronger Laboratory Systems in Resource-Limited Countries – My Reflections


Over the past decade, resource-limited countries have experienced the devastating effects—including increased disability and mortality—of infectious diseases. In sub-Sahara Africa, AIDS, tuberculosis, and malaria lead infectious disease mortality, with HIV claiming 34 million lives in the region so far. Of the 36 million people who live with HIV (PLHIV), 26 million, (or 70 percent), live sub-Saharan Africa.

Development partners and local governments have implemented a variety of system-strengthening strategies to reduce the effects of infectious diseases and improve health outcomes. The Millennium Development Goals, the Global Health Security Agenda, the Maputo Declaration on harmonization and standardization, and the Diagnostics Access Initiatives (DAI) are among the global strategies to improve access to health care services in resource-limited countries. But although they have measured success in some areas, none has achieved its goals.

On this World AIDS Day, I want to focus on efforts to provide cost-effective, quality-assured diagnostics, treatment, and monitoring of HIV/AIDS in resource-limited sub-Saharan Africa.

HIV testing is the critical entry point to sustained treatment and quality of life for PLHIV. Over the years, HIV testing has transformed from complex laboratory-based viral detection that takes weeks to complete to a rapid simple test that detects the presence of antibodies to HIV-1/2 and/or HIV p24 antigen. This revolution has led to large-scale uptake of HIV testing, care, and treatment in HIV-endemic sub-Sahara Africa countries. In 2014, for instance, approximately 150 million children and adults in 129 low- and middle-income countries received HIV testing services—but this represents only 51 percent of people who need these services. And while more than 13 million HIV-infected people are now receiving antiretroviral therapy (ART) in sub-Saharan Africa, 32 million—or 40 percent of PLHIV—are not.

Despite substantial improvement in HIV testing and more effective ARV drugs, it will take tremendous effort to meet the Sustainable Development Goals related to eradicating infectious diseases by 2030. The recent UNAIDS introduction of 90-90-90 goal—test 90 percent of people who need it; get 90 percent of those who test positive on treatment; and 90 percent of those on treatment virally suppressed—will require enormous investments in laboratories in developing countries.

JSI’s Supply Chain Management Systems (SCMS) project has been doing just that since 2008. The project has built stronger laboratory supply chain systems in countries including Zambia, Zimbabwe, Mozambique, Rwanda, and Nigeria, which has led to improved overall health outcomes, specifically for people living with AIDS through more efficient testing services. It is my hope that in the coming years, such efforts will help improve HIV testing rates from 51 to 90 percent and ART from 40 to 90 percent, and that an HIV-free generation will finally be born.

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