An exciting extension of the African Regional Collaborative for Nurses and Midwives was launched in Johannesburg South Africa 18-19 February 2016. The new initiative, titled the Laboratory Regional Collaborative or LARC, is aimed at improving communication between laboratory technologists and technicians and nurses and midwives.
The UNAIDS 90-90-90
goals aim by 2020: 90% of all people living with HIV will know their HIV status;
90% of all people with diagnosed HIV infection will receive sustained ART; and
90% of all people receiving ART will have viral suppression.
these goals is identification and referral for viral load testing; efficient
specimen collection and processing; timely and accurate testing; and result
reporting and interpretation by clinicians
that leads to appropriate patient management.
between laboratory personnel and clinicians along the continuum is essential to
achieving the 90-90-90 goals. The LARC initiative will provide time limited
grants to six countries (Kenya, Malawi, Mozambique, Swaziland, Tanzania, and Uganda) to work on projects
to improve communication and understanding between these two critical groups of
Optimizing the use of HIV diagnostics (first ‘90’), accelerating access of HIV-infected adults, adolescents and children to ART (second ‘90’), and achieving and maintaining HIV Viral Load (VL) suppression (third ‘90’) are necessary to control the HIV epidemic.
To effectively achieve accurate HIV testing, treatment and viral load suppression scale-up targets, there needs to be continuous quality improvement (CQI) in laboratory systems, early diagnosis of HIV and TB, and timely linkage to treatment with a monitoring strategy to ensure that treatment is effective. Uptake of best practices, government commitments along with strong leadership and partnerships is also necessary.
The International Laboratory Branch (ILB) Headquarters Operational Plan (HOP) of the CDC has developed a project which adapts the highly successful, continuous quality improvement (CQI) problem-solving regional collaborative used by nurses and midwives (ARC) to the laboratory workforce.
More specifically, the African Regional Collaborative for Laboratory Technologists and Technicians or LARC, will engage national teams of laboratory and nurse leaders from the six viral load countries
mentioned above to identify and address health systems barriers that impede the integration of viral load testing within patient care – especially HIV care provided by mid-level providers (eg: nurses and midwives) who are responsible (through task sharing) for managing patient treatment on first-line of antiretroviral therapy (ART).
In 2016, the targeted, 12 month interventions developed by each country team will be supported by grants of up to US$10,000. The projects will be developed by the respective country collaborative (comprised of national laboratory technologists and nursing and midwifery leaders) and submitted by each team for project review conducted by Emory University.
The review and approval of these short-term 'winnable battle' projects will engage CDC (HESIB and ILB) and Emory University staff. Each project interventions must address system impediments illustrated at either the end of the viral load cascade (see diagram opposite). LARC’s evaluation will incorporate a Capability Maturity Model designed specifically for assessing laboratory health systems improvement that has been used to assess the progress of the ARC initiative.
The LARC intervention was launched at a meeting that convened in Johannesburg South Africa on February 18-19, 2016. Participants attending this meeting included:
- CDC Laboratory Advisor or representative for each viral load country,
Two laboratory leaders per country that have been identified by each respective CDC Laboratory Advisor,
- Nurse and midwifery leaders from each viral load country. and
- ARC and LARC Faculty members.
2016, there will be two LARC 'learning session', that will allow country teams to report on their viral load health systems projects and share related success and challenges with project implementation. The forum is also designed to foster 'south-to-south' learning.
LARC’s goal is to achieve and maintain HIV VL suppression (the 3rd '90') by:
- Increasing the uptake of viral load testing (addressed in the viral load scale-up cascade in the diagram above); and
- Improving institutional capacity, leadership and normative guidance.
LARC's specific objective is to advance the understanding and utilization of HIV laboratory diagnostics and address system-level barriers through continuous quality improvement and the integration of best practices.