# Understanding and Improving the Effectiveness of Public Health Laboratory Networks for Infectious Diseases in Ghana

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2020 · $679,698

## Abstract

Project Summary
Despite recent advances, infectious diseases still account for 50% of years of life lost in sub-Saharan Africa.
There has been growing international agreement that a critical roadblock to controlling this epidemic and
endemic health burden has been the suboptimal design of laboratory networks. The Global Health Security
Agenda (GHSA) requires countries to establish a tiered national laboratory system and “determine the level of
diagnostic capability practical and needed at each level of the public health hierarchy from national to district.”
Testing at lower tier laboratories improves turn-around time and can utilize simpler assays but adds costs and
may sacrifice quality. By contrast, testing at higher tier laboratories may ensure better quality but requires
transporting patient samples, with attendant delays and losses to follow-up. The optimal allocation of
diagnostic resources is not obvious and decision makers must weigh many factors for multiple pathogens and
available assays to establish a rational basis of a National Laboratory Strategic Plan.
The overall objective of the proposed research is to identify the ideal placement of diagnostic testing for high
priority infectious diseases in resource-limited countries, using Ghana as an example. To accomplish this
objective, we will characterize the implementation, effectiveness, and efficiency of diagnosing key infectious
diseases at different tiers and geographic/epidemiological settings within the Ghanaian public health laboratory
network. We have selected a mix of three epidemic-prone diseases (EPDs: bacterial meningitis, yellow fever
and measles) and three diseases of public health importance (DPHIs: HIV, tuberculosis and hepatitis C virus).
We will seek to identify the optimal (i.e., most effective and most cost-effective, within a given affordability
envelope) level of laboratory-based diagnostic testing for these 6 key infectious diseases as a function of
disease progression, assay availability, and tiered system by developing a detailed suite of agent-based
simulation models. As laboratory networks must function for all infectious diseases, a key innovation of our
model is the integration of multiple conditions with different diagnostic testing algorithms, rather than focusing
only on a single disease system. In Aim 1, we will collect empirical data on laboratory characteristics (e.g., tier,
remoteness, test availability, testing delays, courier performance, costs), diagnostic effectiveness (estimated
proportion of diagnoses that are both accurate and timely), and diagnostic efficiency (e.g., unit cost and cost
per accurate/timely diagnosis). This will enable characterization of the current capacity and effectiveness of
Ghana's public health laboratory network. In Aim 2, we will develop and integrate a streamlined set of
simulation models that estimate relevant disease-specific outcomes for these priority EPD-DPHIs (e.g., number
HIV-positive infants with timely ART init...

## Key facts

- **NIH application ID:** 9890998
- **Project number:** 5R01AI136977-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** David Wesley Dowdy
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $679,698
- **Award type:** 5
- **Project period:** 2019-03-11 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9890998

## Citation

> US National Institutes of Health, RePORTER application 9890998, Understanding and Improving the Effectiveness of Public Health Laboratory Networks for Infectious Diseases in Ghana (5R01AI136977-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9890998. Licensed CC0.

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