Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-3 (of 3 Records) |
Query Trace: Zeh CE[original query] |
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Laboratory medicine in Africa since 2008: then, now, and the future
Nkengasong JN , Mbopi-Keou FX , Peeling RW , Yao K , Zeh CE , Schneidman M , Gadde R , Abimiku A , Onyebujoh P , Birx D , Hader S . Lancet Infect Dis 2018 18 (11) e362-e367 The Maputo Declaration of 2008 advocated for commitment from global stakeholders and national governments to prioritise support and harmonisation of laboratory systems through development of comprehensive national laboratory strategies and policies in sub-Saharan Africa. As a result, HIV laboratory medicine in Africa has undergone a transformation, and substantial improvements have been made in diagnostic services, networks, and institutions, including the development of a competent workforce, introduction of point-of-care diagnostics, and innovative quality improvement programmes that saw more than 1100 laboratories enrolled and 44 accredited to international standards. These improved HIV laboratories can now be used to combat emerging continental and global health threats in the decades to come. For instance, the unprecedented Ebola virus disease outbreak in west Africa exposed the severe weaknesses in the overall national health systems in affected countries. It is now possible to build robust health-care systems in Africa and to combat emerging continental and global health threats in the future. In this Personal View, we aim to describe the remarkable transformation that has occurred in laboratory medicine to combat HIV/AIDS and improve global health in sub-Saharan Africa since 2008. |
Stringent HIV viral load threshold for virological failure using dried blood spots: is the perfect the enemy of the good?
Inzaule SC , Hamers RL , Zeh CE , Rinke de Wit TF . J Acquir Immune Defic Syndr 2015 71 (1) e30-3 Since 2013, World Health Organization (WHO) recommends plasma HIV viral load (VL) as the preferred monitoring strategy of antiretroviral therapy (ART), complementing clinical and immunological criteria.1 VL monitoring enables accurate detection of virological failure prompting timely adherence counseling and regimen switches before drug resistance accumulates,2 and also prevention of inappropriate switching to more costly second-line regimens.2 | Despite significant progress,3 there are major obstacles to scaling up VL testing in low-income and middle-income countries (LMICs), including high costs, complex sample logistics, limited laboratory infrastructure, and shortage of skilled staff. With point-of-care applications still largely unavailable,4 dried blood spots (DBS), rather than plasma, are propagated,5,6 because of the advantages of easy sample collection through finger prick (eliminating phlebotomy and centrifugation) and easy shipment to a reference laboratory at ambient temperature (eliminating cold-chain transportation).7–9 However, potential limitations of DBS include lower amplification sensitivity (due to small sample volumes) and lower specificity (contribution by cell-associated viruses may overestimate VL).7–10 | To account for these limitations, WHO previously recommended a VL threshold for virological failure of 3000–5000 copies per milliliter with DBS, compared to 1000 copies per milliliter with plasma.1 However, a 2014 WHO technical update revised the threshold with DBS to 1000 copies per milliliter, citing provisional data from a review by Clinton Health Access Initiative on 5 commercial VL assays, which suggested sufficient sensitivities for this threshold.6 |
Field experience in implementing ISO 15189 in Kisumu, Kenya
Zeh CE , Inzaule SC , Magero VO , Thomas TK , Laserson KF , Hart CE , Nkengasong JN . Am J Clin Pathol 2010 134 (3) 410-418 Quality medical laboratory services are an integral part of routine health care, medical research, and public health systems. Despite this vital role, quality laboratory services in Africa are scarce. The crucial need for expanding quality laboratory services throughout sub-Saharan Africa is especially critical because of the region's burden of disease. Fortunately, several plans from supporting international partners are underway to help strengthen laboratory infrastructure in this region. A key component of these initiatives is the enforcement of quality assurance services through accreditation by international standards such as the International Organization for Standardization (ISO) 15189. However, acquisition and maintenance of these standards are a significant challenge, especially in resource-limited settings. The most common limiting factors can include funding, government support, equipment, training opportunities, and poor procurement infrastructure. In this article, we discuss the challenges and benefits accrued in pursuing and sustaining ISO 15189 accreditation for the Kenya Medical Research Institute/Centre for Disease Control HIV-Research Laboratory in Kisumu, Kenya. |
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