The Africa Centres for Disease Control and Prevention (Africa CDC) and World Health Organization (WHO) Regional Office for Africa (AFRO) are building a global health security programme that aims to strengthen both regional and national health through networked, collaborative efforts to improve infectious disease and antimicrobial resistance surveillance. To achieve this, the Africa CDC is calling for a data-sharing platform that can be leveraged across member states and disease areas, strengthening the ability to collate, analyse and interpret data, and to respond with the appropriate action. Although numerous disease intelligence and surveillance systems exist, they are plagued with inaccurate or untimely data. We contend, furthermore, that it was this lack of data quality - and not the lack of surveillance systems or networks - that prevented the global community from acting earlier in response to the Ebola outbreak in 2014-2016. The new field of 'connected diagnostics' is one solution to this concern, as it automates data collection directly from the diagnostic instruments to multiple levels of stakeholders for real-time decision-making and policy response. This article details how the intervention of 'connected diagnostics' could solve the primary underlying failure in existing surveillance systems - the lack of accurate and timely data - to enable difficult political decisions earlier. The use of connectivity solutions can enable critical health and operational data to empower the Africa CDC, regional hubs, and each country with a consistent and automated data feed while still maintaining country privacy and controls.

BACKGROUND: Laboratory services are essential at all stages of the tuberculosis care cascade, from diagnosis and drug resistance testing to monitoring response to treatment. Enabling access to quality services is a challenge in low-resource settings. Implementation of a strong quality management system (QMS) and laboratory accreditation are key to improving patient care. OBJECTIVES: The study objective was to determine the status of QMS implementation and progress towards accreditation of National Tuberculosis Reference Laboratories (NTRLs) in the African Region. METHOD: An online questionnaire was administered to NTRL managers in 47 World Health Organization Regional Office for Africa member states in the region, between February and April 2015, regarding the knowledge of QMS tools and progress toward implementation to inform strategies for tuberculosis diagnostic services strengthening in the region. RESULTS: A total of 21 laboratories (43.0%) had received SLMTA/TB-SLMTA training, of which 10 had also used the Global Laboratory Initiative accreditation tool. However, only 36.7% of NTRLs had received a laboratory audit, a first step in quality improvement. Most NTRLs participated in acid-fast bacilli microscopy external quality assurance (95.8%), although external quality assurance for other techniques was lower (60.4% for first-line drug susceptibility testing, 25.0% for second-line drug susceptibility testing, and 22.9% for molecular testing). Barriers to accreditation included lack of training and accreditation programmes. Only 28.6% of NTRLs had developed strategic plans and budgets which included accreditation. CONCLUSION: Good foundations are in place on the continent from which to scale up accreditation efforts. Laboratory audits should be conducted as a first step in developing quality improvement action plans. Political commitment and strong leadership are needed to drive accreditation efforts; advocacy will require clear evidence of patient impact and cost-benefit.

The Ebola outbreak in West Africa underlined the urgent need for integration of public health systems, including the establishment of national laboratory networks, surveillance systems, and health research institutions at all levels of service delivery. The integration schema presented here would assist in driving the immediate steps needed for integration of public health systems, particularly laboratory networks, in support of the implementation of International Health Regulations and the Global Health Security Agenda in the African region. Increased funding, political willingness from countries, and coordination through enhanced technical assistance from international partners, are critical in achieving this objective.

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance.

Over recent years, tuberculosis (TB) and disease caused by human immunodeficiency virus (HIV) have merged in a synergistic pandemic. The number of new cases of TB is stabilizing and declining, except in countries with a high prevalence of HIV infection. In these countries, where HIV is driving an increase in the TB burden, the capacity of the current tools and strategies to reduce the burden has been exceeded. This paper summarizes the current status of TB management and describes recent thinking and strategy adjustments required for the control of TB in settings of high HIV prevalence. We review the information on anti-TB drugs that is available in the public domain and highlight the need for continued and concerted efforts (including financial, human and infrastructural investments) for the development of new strategies and anti-TB agents.

A lo largo de los últimos años, la tuberculosis y la enfermedad causada por el virus de la inmunodeficiencia humana (VIH) se han fusionado en una pandemia sinérgica. El número de casos nuevos de tuberculosis se está estabilizando o disminuyendo, excepto en los países con alta prevalencia de infección por VIH. En estos países, donde el VIH está causando un aumento de la carga de tuberculosis, la capacidad de los instrumentos y estrategias actualmente disponibles para reducir esa carga se ha visto desbordada. En este artículo se resume el estado actual del tratamiento de la tuberculosis y se describen los últimos cambios teóricos y estratégicos requeridos para controlar la enfermedad en los entornos de alta prevalencia de infección por VIH. Revisamos la información sobre medicamentos antituberculosos disponible en el dominio público y resaltamos la necesidad de hacer un esfuerzo continuo y concertado (en particular mediante inversiones financieras, humanas y en infraestructura) para desarrollar nuevas estrategias y nuevos agentes antituberculosos.

Ces dernières années, on a observé une grande synergie entre la tuberculose (TB) et la maladie provoquée par le virus de l'immunodéficience humaine (VIH), conduisant à une pandémie de co-infection VIH/TB. Le nombre de nouveaux cas de TB est en cours de stabilisation ou de déclin, sauf dans les pays subissant une forte prévalence des infections à VIH. Dans ces pays, où la propagation du VIH est le moteur d'une augmentation de la morbidité tuberculeuse, la capacité des outils et des stratégies actuellement disponibles pour réduire la charge de morbidité due à cette maladie est dépassée. Le présent article récapitule la situation actuelle en matière de prise en charge de la TB et expose les nouveaux ajustements intellectuels et stratégiques nécessaires pour lutter contre la tuberculose dans les pays à forte prévalence du VIH. Il examine les données relatives aux antituberculeux disponibles dans le domaine public et souligne la nécessité d'efforts ininterrompus et concertés (y compris des investissements dans les domaines financiers et humains et dans les infrastructures) pour mettre au point de nouvelles stratégies et de nouveaux agents antituberculeux.