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Background: Achievement of ISO15189 accreditation demonstrates competency of a laboratory to conduct testing. Three programmes were developed to facilitate achievement of accreditation in low‐ and middle‐income countries: Strengthening Laboratory Management Towards Accreditation (SLMTA), Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) and Laboratory Quality Stepwise Implementation (LQSI). Objective: To determine the level of accreditation and associated barriers and facilitators among medical laboratories in the WHO‐AFRO region by 2020. Methods: A desk review of SLIPTA and SLMTA databases was conducted to identify ISO15189‐accredited medical laboratories between January 2013 and December 2020. Data on access to the LQSI tool were extracted from the WHO database. Facility and country characteristics were collected for analysis as possible enablers of accreditation. The chi‐square test was used to analyse differences with level of significance set at <0.05. Results: A total of 668 laboratories achieved accreditation by 2020 representing a 75% increase from the number in 2013. Accredited laboratories were mainly in South Africa (n = 396; 55%) and Kenya (n = 106; 16%), two countries with national accreditation bodies. About 16.9% (n = 113) of the accredited laboratories were registered for the SLIPTA programme and 26.6% (n = 178) for SLMTA. Approximately 58,217 LQSI users were registered by December 2020. Countries with a higher UHC index for access to HIV care and treatment, higher WHO JEE scores for laboratory networks, a larger number of registered LQSI users, with national laboratory policy/strategic plans and PEPFAR‐priority countries were more likely to have an accredited laboratory. Of the 475 laboratories engaged in the SLIPTA programme, 154 attained ≥4 SLIPTA stars (ready to apply for accreditation) and 113 achieved ISO 15189 accreditation, with 96 enrolled into the SLMTA programme. Lower‐tier laboratories were less likely to achieve accreditation than higher‐tier laboratories (7.7% vs. 30%) (p < 0.001). The probability of achieving ISO 15189 accreditation (19%) was highest during the first 24 months after enrolment into the SLIPTA programme. Conclusion: To sustainably anchor quality improvement initiatives at facility level, national approaches including access to a national accreditation authority, adoption of national quality standards and regulatory frameworks are required. [ABSTRACT FROM AUTHOR]

In Africa, compared to 2019, dengue infections have surged ninefold by December 2023, with over 270 000 cases and 753 deaths reported across 18 African Union (AU) Member States. This commentary synthesises the context of dengue outbreaks in Africa and provides recommendations for sustainable control. In 2023, 18 African Union Member States reported outbreaks of dengue, among which seven had ongoing armed conflicts. These countries were amongst the top 15 African countries contributing to the most displaced persons on the continent and accounted for 98% of all dengue cases reported in the continent in 2023. Climate change remains an important driver, both through the displacement of people and global warming. The continent continues to face several challenges in detection, reporting and management, such as the lack of local laboratory capacity, misclassification of dengue cases and lack of medical countermeasures. Solutions targeting the strengthening of cross-border surveillance and early warning systems using a multisectoral one-health approach, local research and development for therapeutics and diagnostics and community engagement empowering communities to protect themselves and understand the gravity of the threat could help curb the spread of the disease in Africa., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Objective: To determine viral load (VL) nonsuppression (VLN) rates, HIV drug resistance (HIVDR) prevalence, and associated factors among female sex workers (FSWs) in Ethiopia., Methods: A cross-sectional biobehavioral survey was conducted among FSWs in 11 cities in Ethiopia in 2014. Whole blood was collected, and HIVDR genotyping was performed. Logistic regression analysis was performed to identify factors associated with VLN and HIVDR., Results: Among 4900 participants, 1172 (23.9%) were HIV-positive and 1154 (98.5%) had a VL result. Participants were categorized into antiretroviral therapy (ART) (n = 239) and ART-naive (n = 915) groups based on self-report. From the 521 specimens (ART, 59; ART-naive, 462) with VL ≥1000 copies/mL, genotyping was successful for 420 (80.6%) and 92 (21.9%) had drug resistance mutations (DRMs). Pretreatment drug resistance (PDR) was detected in 16.5% (63/381) of the ART-naive participants. Nucleoside reverse transcriptase inhibitor (NRTI), non-NRTIs (NNRTIs), and dual-class DRMs were detected in 40 (10.5%), 55 (14.4%), and 35 (9.2%) of the participants, respectively. Among 239 participants on ART, 59 (24.7%) had VLN. Genotyping was successfully performed for 39 (66.1%). DRMs were detected in 29 (74.4%). All 29 had NNRTI, 23 (79.3%) had NRTI or dual-class DRMs. VLN was associated with age 35 years or older, CD4+ T-cell count <350 cells/mm3, and being forced into selling sex. PDR and acquired drug resistance were associated with CD4+ T-cell count <350 cells/mm3 (P < 0.001)., Conclusions: The high VLN and HIVDR rates among FSWs underscore the need for targeted interventions to improve ART access and virologic monitoring to maximize the benefit of ART and limit the spread of HIV and HIVDR., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: CD4+ T-lymphocyte count testing at the point-of-care (POC) may improve linkage to care of persons diagnosed with HIV-1 infection, but the accuracy of POC devices when operated by lay-counselors in the era of task-shifting is unknown. We examined the accuracy of Alere's Pima™ POC device on both capillary and venous blood when performed by lay-counselors and laboratory technicians., Methods: In Phase I, we compared the perfomance of POC against FACSCalibur™ for 280 venous specimens by laboratory technicians. In Phase II we compared POC performance by lay-counselors versus laboratory technicians using 147 paired capillary and venous specimens, and compared these to FACSCalibur™. Statistical analyses included Bland-Altman analyses, concordance correlation coefficient, sensitivity, and specificity at treatment eligibility thresholds of 200, 350, and 500cells/μl., Results: Phase I: POC sensitivity and specificity were 93.0% and 84.1% at 500cells/μl, respectively. Phase II: Good agreement was observed for venous POC results from both lay-counselors (concordance correlation coefficient (CCC)=0.873, bias -86.4cells/μl) and laboratory technicians (CCC=0.920, bias -65.7cells/μl). Capillary POC had good correlation: lay-counselors (CCC=0.902, bias -71.2cells/μl), laboratory technicians (CCC=0.918, bias -63.0cells/μl). Misclassification at the 500 cells/μl threshold for venous blood was 13.6% and 10.2% for lay-counselors and laboratory technicians and 12.2% for capillary blood in both groups. POC tended to under-classify the CD4 values with increasingly negative bias at higher CD4 values., Conclusions: Pima™ results were comparable to FACSCalibur™ for both venous and capillary specimens when operated by lay-counselors. POC CD4 testing has the potential to improve linkage to HIV care without burdening laboratory technicians in resource-limited settings., (Published by Elsevier B.V.)

Background: Bacterial bloodstream infections cause substantial morbidity and mortality, with up to one-quarter of affected patients dying as a result of their infection. Up-to-date information on blood culture isolates and their antimicrobial susceptibility pattern is very important as guide for immediate prescription of antimicrobial agents and monitoring of emergence of drug resistant strains., Objective: To determine the frequency of blood culture isolation and antimicrobial susceptibility pattern of isolates in Gondar University teaching hospital., Methods: This was retrospective analysis of records of blood culture results for febrile patients seen at Gondar University teaching hospital, bacteriology section from March 2001 to April 2005., Results: During the four years period, blood cultures were done for a total of 472 febrile patients. Among these, 233 (49.4%) were females and 239 (50.6%) were males. The median age was 20.5 years (age range of 2 hours to 78 years). Out of these, total of 114 bacterial strains were isolated with culture positivity rate of 24.2%. Coagulase-negative Staphylococci (CoNS) were isolated with the highest frequency in 38 (33.3%), followed by Staphylococcus aureus in 34 (29.8%), Salmonella species other than Salmonella typhi in 12 (10.5%), Klebsiella species in 10 (8.8%), Streptococcus pneumoniae in 6 (5.3%), Salmonella typhi in 4 (3.5%), Enterobacter species in 3 (2.6%), Escherichia coli in 2 (1.7%). The gram positive and gram negative bacteria constituted 80 (70.2%) and 34 (29.8%) of the culture isolates, respectively. Culture positivity rates vary as for neonates, 63% (17 out of 27);followed by 25.6% (36 out of 141) in children and 20% (61 out of 304) in adults. The isolates especially gram negative bacteria showed multiple drug resistance, to Ampicillin and penicillin. However, ciprofloxacin is fairly effective against both gram negative and gram positive isolates., Conclusion: An effective documented data may serve as a guide for initial empirical treatment of bloodstream infections but in view of these findings the presented data is only imperative to do large-scale prospective and quantitative studies. More importantly, an ongoing surveillance for antimicrobial susceptibility is of the essence to enhance efforts to identify resistance and attempt to limit its spread.