The Tropical Lab Initiative (TLI) is designed to fill this research and operational gap by “rethinking” the traditional laboratory and making diagnostics more readily available to patients in rural and remote areas. The TLI has three primary objectives:
- Reduce the number of missed and misdiagnosed cases
- Provide an entry point into clinical care, particularly through the delivery of diagnostics and treatment at the household level
- Significantly reduce morbidity and mortality associated with malaria, HIV/AIDS, tuberculosis (TB), neglected tropical diseases, and pregnancy-related complications.
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Diagnostics and Laboratory Services
The goal of the TLI is to develop and validate an integrated package of diagnostics that can be easily deployed at the point of care in remote rural communities. Diagnostics are crucial for identifying the presence and cause of disease at both the individual and population levels, correctly assessing the nature of the disease, designating an appropriate course of treatment, monitoring the effects of interventions, and determining drug resistance. However, despite the key role of diagnostics, they receive less attention than research efforts focused on novel therapeutics or vaccines.+
Increasing access to diagnostics in remote rural areas has the potential to dramatically improve the effectiveness of public health efforts. Ensuring that diagnostic tools are available not only at referral centers, but also at local facilities and even households, allows diagnosis to be made quickly so that patients are able to rapidly commence appropriate and often life-saving treatment. The project has developed and validated an integrated package of diagnostics that can be administered at the point of care in sub-Saharan Africa, with a specific focus on making available the latest high-impact, low-cost technologies. The package of diagnostics covers the main investigations required for antenatal care, as well as tests for malaria, HIV/AIDS, tuberculosis, neglected tropical diseases, and basic biochemical analysis. This package of integrated interventions can be implemented simultaneously at just $110 per capita over a 5 to 10 year period.
As a result of this project, not only will patients have access to faster and more reliable results, but the TLI will also strengthen the continuum of care in remote districts that have limited access to high quality health facilities and laboratory systems.
TLI Laboratories
TLI laboratories will be developed in two phases. Phase one aims to improve access to diagnostics through the creation of a new vision for clinical laboratories at the health center, clinic, health post, and household level.+
This phase requires a critical appraisal of current service provision, which informs a rethinking of several aspects of traditional lab work. Phase one work is therefore focusing on:
Lab diagnostic and specimen handling equipment
There is a need to rethink the health center laboratory so that it includes a range of reliable, affordable, user-friendly, and context-appropriate tools to detect and monitor illnesses. The TLI focuses on either rapid diagnostic tests to reduce the need for technicians to engage in complicated diagnostic techniques, or easily performed tests that require minimum training and supervision, and can be performed without expensive energy-intensive equipment.
Laboratory redesign
Often it is critical to engage in a physical redesign of the traditional rural clinic laboratory to address necessary physical requirements, such as electricity, plumbing, sewage, etc., and to ensure personnel safety.
Integration with local, state, and regional initiatives
Sustainability of the project is in part dependent upon developing a context-appropriate model that integrates with already existing local health structures at District, Regional, and National level in each country where the TLI operates.
Process definition and quality control
Critical to ensure quality of the project is the design of easy to use, and easy to implement, quality assurance and quality control protocols for use at each lab facility.
Community health worker roles and responsibilities
Community health workers (CHWs) play a key role in extending the reach of health services to the household level. To aid in their activities and effectiveness, a diagnostic “toolbox” for CHWs will be deployed that will aid in early detection and timely referral to health facilities. This will ultimately be complemented by CommCare, and mHealth (mobile health) initiative that enables community health workers to collect real time household data via a mobile phone. The program will trigger alerts, reminders, and health promotion messages for the CHWs.
Building human capacity and competency
Labeling samples in the laboratory
Lab technicians have the capability to conduct innovative cutting-edge diagnostics once trained on techniques to appropriately deploy new tests, carry out maintenance of equipment, and ensure biosafety of employees and patients.This phase will specifically focus on a simple but comprehensive diagnostics package aimed at addressing key Millennium Development Goal targets and closely integrated with other health activities throughout the Millennium Villages, such as:
- HIV rapid diagnostic tests and portable CD4 count equipment
- Malaria rapid diagnostic tests
- TB sputum collection and transport system (wherever TB microscopy is not available)
- Semi-automated microscope for TB detection
- Integrated pregnancy package, including rapid pregnancy testing, HIV, syphilis, anaemia, glucose tests, and mobile ultrasound for screening and monitoring pregnancies.
In phase two of the initiative, the TLI will work closely with partners to identify new critical tools developed in recent years, and integrate the best-in-class component technologies into the already existing diagnostic package, therefore further improving the overall impact of the Tropical Lab Initiative.
TLI in Bonsaaso, Ghana
The Bonsaaso Millennium Village in Ghana is the first MVP site to have rolled out the Tropical Lab Initiative. Where access to local health centres has been poor and complicated by long commutes, villagers now have seven functional health centres that link directly to the new laboratory facility launched by TLI.+
The project was designed to incorporate existing local and regional operations, in order to have access to a wider range of diagnostic equipment including CD4 count and PCR for HIV diagnosis. Previously, these were only available at the district and regional levels.As of the end of 2012, a fully functional laboratory has opened, and laboratory and medical staff have received training on the integrated diagnostic package.
The Bonsaaso TLI project is a collaboration between the Millennium Villages Project
Bonsaaso Health Team and the GlaxoSmithKline PULSE program, which enables GSK employees to dedicate six months to a non-profit or NGO.
Contact
For more information on the TLI, please contact Dr. Yanis Ben Amor.