Abstract
BackgroundA major challenge facing South Africa is the concomitant HIV and tuberculosis epidemics. The National Health Laboratory Service provides testing for staging HIV-positive patients, monitoring patients on antiretroviral therapy (ART) and diagnosing tuberculosis. Not all health districts have equivalent ART-related coverage in particular for CD4 and HIV viral load testing.ObjectivesThe Integrated Tiered Service Delivery Model coverage precinct approach was used to address ART-related testing service coverage gaps in a manner that balances cost, quality and equity.MethodsAn algorithm was developed to identify and address ART-related diagnostic coverage gaps. Data was extracted from the corporate data warehouse and Oracle systems for the period of April 2015 to March 2016. Daily test volumes were based on 21.73 working days per month. Data were analysed using MS Excel and mapped using ArcCatalog and ArcMap. Capacity analysis was informed by the available testing-platforms.ResultsHealth district daily HIV viral load volumes ranged from 2 to 1308 samples. Nineteen candidate laboratories were identified to address the coverage gaps. Following the proximity analysis, testing was consolidated at four candidate laboratories, resulting in 13 revised candidate laboratories. The revised candidate laboratory daily HIV viral load referrals ranged between 5 and 205 samples, with CD4 volumes between 6 and 85 samples. Remaining coverage gaps were identified in seven municipalities.ConclusionsThe study demonstrated that the service coverage precinct approach could be used to identify coverage gaps for a defined ART-related testing repertoire.
Highlights
It is estimated that 36.7 million people globally were living with HIV in 2016, with a prevalence of 0.8%, of which 25.5 million people live in sub-Saharan Africa (~70% of the global HIV burden).[3,4]
In South Africa, it is estimated that seven million people are living with HIV, with an adult prevalence rate of 19.2% in 2015.4,5 Despite many obstacles faced by South Africa between 2010 and 2014, the response to the AIDS epidemic resulted in the largest antiretroviral treatment (ART) programme in the world, with over two million HIV-infected people receiving treatment by 2010.6
Poor coverage was identified across all Legend HIV Viral Load Laboratories
Summary
The required ART scale up in South Africa necessary to meet the HIV counselling and testing campaign targets led to the announcement that accreditation would be abandoned and that all public healthcare facilities would be geared up to provide ART.[7,8] With the accreditation requirement removed, ART services were decentralised to the majority of health facilities over the few years (n = ~3000).[7] This change removed the need for a national team to accredit health facilities for ART provision. The National Health Laboratory Service provides testing for staging HIV-positive patients, monitoring patients on antiretroviral therapy (ART) and diagnosing tuberculosis. Not all health districts have equivalent ART-related coverage in particular for CD4 and HIV viral load testing
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