We found evidence for training effectiveness that the course familiarized participants on the core elements of laboratory safety and taught them how to successfully transfer learned knowledge and skills to their facilities. PEPFAR funded biosafety program at ACILT had an impact in building capacity for biosafety practices in participant’s laboratories. A systematic review based on 22 studies for hazards in occupational health and safety (OHS) programs traced evidence for training effectiveness, including (i) knowledge, (ii) attitudes and beliefs, (iii) behaviors, and (iv) health outcomes. Strong evidence was found for the effectiveness of training on worker OHS behaviors, but insufficient evidence was found of its effectiveness on health outcomes [25]. Our study may be one of the few published on biosafety that have shown evidence for successful training effectiveness at levels 3 and 4 of Kirkpatrick model.
A higher number of participants from non-accredited laboratories were motivated to apply learning at their facilities after completing the course, which is indicative of a participant’s understanding and recognition of the importance of biosafety practices to achieve accreditation.
Our analysis identified three factors that shaped the response in strengthening biosafety programs at the participant’s facilities, both at facility and national level. These factors included having (a) a safety policy, (b) laboratory safety committee, and (c) dedicated available resources for safety. Furthermore, countries with accredited laboratories, national safety regulations, laboratory strategies and goals, and designated biosafety officers showed improvements in biosafety programs. Our findings are corroborated by studies providing suggestions for sustainable capacity development for biosafety and biosecurity challenges in low resource countries [26], important role of biosafety officers [27] and lapses in laboratory biosafety operations due to lack of one [28].
Our results also confirmed that facility management plays a key role in executing and sustaining safe laboratory operations to provide the necessary resources and ensure implementation of biosafety and biosecurity programs. A strong management commitment showed positive impact on biosafety and biosecurity aspects in Indonesian laboratories too [29].
Improvements in biosafety practices lead to strengthened laboratory operations, preparedness for accreditation, responses to public health emergencies and outbreaks and systems for sustained HIV and TB epidemic control [30, 31]. Between 2017 and 2022, the number of PEPFAR-supported facilities with a molecular laboratory increased by 115%, from 926 to 1,995; and those that were accredited increased by 194%, from 103 to 303 [32]. This enormous growth in accreditation could not be possible without competent biosafety personnel in each facility. Uganda and Kenya with 53 and 85 accredited laboratories, respectively (December 2022), are shining examples of sustainability of biosafety program [33, 34].
Apart from PEPFAR there are additional external factors that have contributed to the successful implementation of the biosafety and biosecurity programs in countries, such as: international policies, e.g., WHO’s International Health Regulations [35]; programs, e.g., Global Health Security Agenda [36] and Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) [37]; partners, e.g., PEPFAR’s Public–Private Partnership [38]; and declarations, e.g., Maputo Declaration [39]. Case in point, in 2007 Kenya received funding from the GF and World Bank (WB) to develop a policy on waste management and a training model to strengthen biosafety and biosecurity laboratory systems [40]. In 2011, WB funded laboratory accreditation efforts, including funds for biosafety, in six laboratories in Kenya and other countries such as Uganda, Tanzania, and Rwanda through the East Africa Public Health Laboratory Network initiative.
Leveraging ACILT’s biosafety program for COVID-19 and other zoonotic diseases—country examples
“ACILT’s biosafety program aimed to reduce risk of occupational and community spread of HIV and TB but had collateral benefits extending to multiple healthcare-associated communicable diseases, such as COVID-19, Ebola, hepatitis and others”—(Communication from Dr. Jane Mwangi, CDC, Kenya).
Following CDC Kenya’s financial support to attend ACILT’s biosafety program, the MoH elevated the health and safety section of the nursing department to a stand-alone, fully staffed Infection Prevention and Control (IPC) Unit. A biosafety unit was established at National Public Health Laboratory Services (NPHL). This unit established Training-of-Trainers to support annual biosafety refresher trainings. In 2019, during the COVID-19 pandemic, the MoH’s headquarter IPC Unit and the NPHL biosafety Unit developed online training material to enable health care workers safely collect, process and test samples safely, as well as handle bodies of deceased from COVID-19.
Between 2017 and 2018, Uganda experience eight disease outbreaks, including those from zoonotic diseases [41]. The outbreaks posed a high risk to the laboratory personnel involved in the outbreaks and response activities and required appropriate biosafety practices to prevent or reduce any exposures to infectious agents. Biosafety trainees both from MoH and partners’ institutions used the knowledge gained at ACILT to ensure safe sample collection, testing and waste management as they were part of a pool of trainers used by the MoH for most of the laboratory capacity building activities. (Communication from Mr. Joel Peter Opio, CDC Uganda).
ACILT’s biosafety program contributed to building sustainable biosafety capacity, long after it was offered. Like Kenya and Uganda many other countries utilized pre-existing healthcare infrastructure which proved to be an important asset in mounting an effective response against a health threat-like COVID-19 [42].
Throughout the COVID-19 pandemic, there was an extreme shortage of personal protective equipment, disinfectants, supplies, but the most extreme shortage was a deficit of qualified, trained staff, including biosafety personnel [43]. Therefore, to increase readiness for the next pandemic, funding and commitment from the governmental bodies to adapt biosafety and biosecurity policies in resource limited conditions were identified as a major need [44].
Challenges
Challenges for funding and lack of management’s support are similar to what other experts have reported as keys to success for biosafety programs and include the importance of policies/strategic laboratory planning [45], strong multisectoral approach [46] and lack of financial resources [47].
Limitations
Limitations to this study included low response rate (20%) partially due to limited access to internet in SSA countries, which was compounded by the mass transition of email addresses by PEPFAR programs from individual country emails to a common CDC email in 2015. A meta-analysis of 39 studies showed that web survey modes have on average a 10% lower response rates than mail surveys [48]. In another self-reported web survey study the overall non-response rate was higher in the self-administered mode (37.9%) than in the face-to-face interview mode (23.7%) [49]. Considering these studies, the response rate in this study is modest. Even with a modest response rate it is evident that participants were able to transfer knowledge and skills in their facilities. Second, the data were retrospectively collected, no statistical tests were conducted to ascertain the statistical significance for before and after the course responses. The data were also self-reported, which could be subject to social desirability, personal and recall biases. Finally, responses from e-questionnaires were de-identified so substantiation of the information, for responders and non-responders, irrespective of the duration of study, could have taken place by one, two or all three of ongoing acceptable systems at ILB a) online routine guidance communication offered by SMEs b) technical assistance visits to countries c) other PEPFAR program assessment reports [49].
Add Comment