The Centrality of Laboratory Services in the HIV Treatment and Prevention Cascade: The Need for Effective Linkages and Referrals in Resource-Limited Settings

Abstract

Strong laboratory services and systems are critical for delivering timely and quality health services that are vital to reduce patient attrition in the HIV treatment and prevention cascade. However, challenges exist in ensuring effective laboratory health systems strengthening and linkages. In particular, linkages and referrals between laboratory testing and other services need to be considered in the context of an integrated health system that includes prevention, treatment, and strategic information. Key components of laboratory health systems that are essential for effective linkages include an adequate workforce, appropriate point-of-care (POC) technology, available financing, supply chain management systems, and quality systems improvement, including accreditation. In this review, we highlight weaknesses of and gaps between laboratory testing and other program services. We propose a model for strengthening these systems to ensure effective linkages of laboratory services for improved access and retention in care of HIV/AIDS patients, particularly in low- and middle-income countries.

Constructing the cascade of HIV care

“…To achieve the reductions in population mortality [5][6][7][8][9][10][11] and transmission [4,[12][13][14][15] that are possible ART, each HIV-positive individual must be diagnosed, know their status, enter into HIV care, undergo clinical examination and laboratory testing [16], initiate ART if eligible under national guidelines, and maintain high levels of retention in care and ART adherence. In reality, even in countries with readily available ART and free access to medical care at the point of use, many HIV-positive individuals are still not benefiting from ART.…”

Strengthening Routine Data Systems to Track the HIV Epidemic and Guide the Response in Sub-Saharan Africa (Preprint)

“…Although the HIV care continuum [9][10][11][12] and 90-90-90 fast-track strategy [13] have given energy to measuring progress and driving scale-up in treatment programs, there remains much to do to ensure progress is accurately tracked. In many sub-Saharan African countries, patient monitoring data come from multiple sources, are of varying quality, and are often recorded electronically long after they have been combined to create aggregate reports.…”

Recent Evidence for Emerging Digital Technologies to Support Global HIV Engagement in Care

“…Furthermore, point-of-care (POC) diagnostics are a developing area essential for preventing patient attrition from HIV care and ensuring opportunistic infections are promptly identified and addressed [26]. …”