Uganda's New National Laboratory Sample Transport System: A Successful Model for Improving Access to Diagnostic Services for Early Infant HIV Diagnosis and Other Programs

Abstract

IntroductionUganda scaled-up Early HIV Infant Diagnosis (EID) when simplified methods for testing of infants using dried blood spots (DBS) were adopted in 2006 and sample transport and management was therefore made feasible in rural settings. Before this time only 35% of the facilities that were providing EID services were reached through the national postal courier system, Posta Uganda. The transportation of samples during this scale-up, therefore, quickly became a challenge and varied from facility to facility as different methods were used to transport the samples. This study evaluates a novel specimen transport network system for EID testing.MethodsA retrospective study was done in mid-2012 on 19 pilot hubs serving 616 health facilities in Uganda. The effect on sample-result turnaround time (TAT) and the cost of DBS sample transport on 876 sample-results was analyzed.ResultsThe HUB network system provided increased access to EID services ranging from 36% to 51%, drastically reduced transportation costs by 62%, reduced turn-around times by 46.9% and by a further 46.2% through introduction of SMS printers.ConclusionsThe HUB model provides a functional, reliable and efficient national referral network against which other health system strengthening initiatives can be built to increase access to critical diagnostic and treatment monitoring services, improve the quality of laboratory and diagnostic services, with reduced turn-around times and improved quality of prevention and treatment programs thereby reducing long-term costs.

Consolidating HIV testing in a public health laboratory for efficient and sustainable early infant diagnosis (EID) in Uganda

“…The Kampala laboratory, depending on sample transport to improve efficiency, began operations in July 2011 and a National Sample and Results Transport Network (NSRTN) later that year. 30 Local networks based at hospitals serve as hubs for all health facilities within a defined catchment area (30-40 km radius). The MoH allotted each hub a motorbike and funds to employ a rider to make (at least) weekly scheduled sample pickups from all its facilities.…”

“…The transport network assured rapid delivery of samples to the high-tech EID laboratory from every health facility in the county. [30][31][32] Evaluating Achievements and Challenges in 2012…”

HIV point-of-care diagnostics: meeting the special needs of sub-Saharan Africa

“…Transportation of samples and relays of test results to and from remote treatment centers and reference laboratories is challenging and costly. Recently, Kiyaga et al reported how Uganda's new coordinated sample transport model increased access to EID services from 36% to 51% [74]. The system significantly reduced transportation costs by 62%, reduced turnaround time by 46.9%, and by a further 46.2% by introducing SMS printers [74].…”

“…Recently, Kiyaga et al reported how Uganda's new coordinated sample transport model increased access to EID services from 36% to 51% [74]. The system significantly reduced transportation costs by 62%, reduced turnaround time by 46.9%, and by a further 46.2% by introducing SMS printers [74]. Improvising near-efficient transport systems and the scale-up of DBS may significantly improve access to laboratory services and HIV care in sub-Saharan countries.…”

Adherence to Early Infant Diagnosis Testing Algorithm, a Challenge to Early Infant Diagnosis Program in Resource Limited Settings of Uganda

“…This innovation was later enhanced by the introduction of the national hub-and-spoke system for DBS sample collection and transport from a network of health facilities to a lab hub from where samples were delivered to the central EID laboratory using the Posta Uganda courier services [11]. EID for exposed infants is not a one off test, but a series over time (6wks to 18months).…”