Progress in Harmonizing Tiered HIV Laboratory Systems: Challenges and Opportunities in 8 African Countries

Williams, Jason D.; Umaru, Farouk; Edgil, Dianna; Kuritsky, Joel N.

doi:10.9745/ghsp-d-16-00004

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…Subsequently, 262 and 16 articles were also excluded following abstract and full screening respectively. Reasons for the exclusion after full article screening were: one study was not conducted in a LMIC [27], two studies reported no evidence of both supply chain management or the primary outcomes of this study [28–30]; four studies reported no information for POC diagnostics [31–34]; three studies had undefined study setting [35–37] and; five studies reported laboratory-based POC testing [38–42]. In all, 15 studies met the study eligibility criteria for data extraction including one study identified following an updated searched.…”

Section: Resultsmentioning

confidence: 99%

Supply chain management and accessibility to point-of-care testing in resource-limited settings: a systematic scoping review

Kuupiel

Bawontuo

Drain

et al. 2019

BMC Health Serv Res

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Background World Health Organization (WHO) has created an essential list of in-vitro diagnostics. Supply chain management (SCM) is said to be the vehicle that ensures that developed point-of-care (POC) tests reach their targeted settings for use. We therefore, mapped evidence on SCM of and accessibility to POC testing (availability and use of POC tests) in low- and middle-income countries (LMICs). Methods We conducted a systematic scoping review using Arksey and O’Malley’s framework as a guide. We searched PubMed; CINAHL; MEDLINE; WEB of Science; Science Direct; and Google Scholar databases for studies that focused on POC diagnostic tests and SCM. The review included studies that were undertaken in 140 countries defined by the World Bank as LMICs published up to August 2017. Two reviewers independently screened the abstracts and full articles against the eligibility criteria. The study used the mixed methods appraisal tool version 2011 to assess the risk of bias for the included studies. NVivo version 11 was employed to extract themes from all included studies and results presented using a narrative approach. Results Of 292 studies identified in this review, only 15 published between 2009 and 2017 included evidence on POC diagnostics and SCM. Of the 15 studies, three were conducted in Zambia, one each in Mozambique, Uganda, Guatemala; South Africa, one in Burkina Faso, Zimbabwe, and one multi-country study (Tanzania, Uganda, China, Peru and Zambia and Brazil). Six studies were not country specific since they were not primary studies. Majority of the studies reported stock-outs of HIV, syphilis, and malaria POC tests. There was a moderate to substantial level of agreement between the reviewers’ responses at full article screening stage (Kappa statistic = 0.80, p < 0.01). Nine studies underwent methodological quality appraisal and all, scored between 90 and 100%. Conclusions The results demonstrated limited published research on SCM of and accessibility to POC testing in LMICs. Further studies aimed at investigating SCM of POC tests in resource-limited settings to identify the barriers/challenges and provide a context-specific evidence-based solutions for policy/decision makers, implementers, and POC developers, funders, and development partners would be essential. PROSPERO registration number CRD42016043711. Electronic supplementary material The online version of this article (10.1186/s12913-019-4351-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Supply chain management and accessibility to point-of-care testing in resource-limited settings: a systematic scoping review

Kuupiel

Bawontuo

Drain

et al. 2019

BMC Health Serv Res

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“…67 Point-of-care (POC) instruments have the potential to be used at birth or later for infant diagnosis per recent WHO guidelines. Though POC instruments require unique maintenance, reagents, and provider training, 68 , 69 field evaluations have shown that POC instruments are feasible for use in infant diagnosis, 70 – 73 where they increase infant retention in care. 74 When coupled with effective clinical and community linkage processes, POC infant testing promises to increase access to testing and improvements in retention among those diagnosed.…”

Section: Strategies To Protect and Build On Pmtct Gainsmentioning

confidence: 99%

Eliminating Mother-to-Child Transmission of HIV by 2030: 5 Strategies to Ensure Continued Progress

Vrazo

Sullivan

Phelps

2018

Glob Health Sci Pract

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To keep up momentum in preventing mother-to-child transmission we propose: (1) advocating for greater political and financial commitment; (2) targeting high-risk populations such as adolescent girls and young women; (3) implementing novel service delivery models such as community treatment groups; (4) performing regular viral load monitoring during pregnancy and postpartum to ensure suppression before delivery and during breastfeeding; and (5) harnessing technology in monitoring and evaluation and HIV diagnostics.

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“…The lessons for VL deployment are to start testing programs by placing devices with appropriate capacity at each testing location. For example, placing high throughput instruments at central test demand locations and lower throughput devices at smaller sites with robust sample referral linkages that maximize instrument utilization and therefore, the return on the investment made for each instrument . This requires data on testing current and projected needs across the network of health facilities, the mapping of sample referral routes, and coordinated national instrument procurement and deployment plans .…”

Section: Improve Testing Efficiencymentioning

confidence: 99%

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

Peter¹,

Zeh²,

Katz

et al. 2017

J Intern AIDS Soc

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IntroductionThe scale‐up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point‐of‐care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low‐resource countries. The purpose of this commentary is to review the challenges and solutions from the large‐scale implementation of other diagnostic tests, namely nucleic‐acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale‐up of VL.DiscussionExperience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale‐up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow‐up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business.ConclusionsThe lessons and innovations from large‐scale EID and CD4 programs described here can be adapted to inform more effective scale‐up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost‐effective test access.

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Progress in Harmonizing Tiered HIV Laboratory Systems: Challenges and Opportunities in 8 African Countries

Cited by 9 publications

References 8 publications

Supply chain management and accessibility to point-of-care testing in resource-limited settings: a systematic scoping review

Supply chain management and accessibility to point-of-care testing in resource-limited settings: a systematic scoping review

Eliminating Mother-to-Child Transmission of HIV by 2030: 5 Strategies to Ensure Continued Progress

Scaling up HIV viral load – lessons from the large‐scale implementation of HIV early infant diagnosis and CD4 testing

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