Abstract
Background: The first pillar of the UNAIDS 90-90-90 goal seeks to accurately identify persons living with HIV (PLHIV), a process that is predicated on facilities having the necessary HIV tests available to perform the task. In many rural settings, the identification of PLHIV is accomplished through a two-step process involving the sequential use of 2 separate rapid diagnostic tests (RDTs). Inadequate inventory of either test has ramifications for the success of HIV-related programs. The purpose of this study was to evaluate the inventory levels of HIV RDT kits at specific healthcare facilities in Zambézia province, Mozambique. Methods: Using facility-level pharmacy stock surveillance data from October 2015 through September 2016, we assessed the inventory levels of HIV RDTs at 75 health facilities in 8 districts within Zambézia province, Mozambique. Using programmatically established categories (good, sufficient, threatened, or stockout), defined in conjunction with the provincial health authorities, descriptive statistics were performed to determine inventory control of HIV RDTs at the district and health facility levels. Monthly proportions of adequate (good + sufficient) inventory were calculated for each district to identify inventory trends over the evaluation period. To assess whether the proportion of inadequate stocks differed between RDT, a mixed-effects logistic regression was conducted, with inadequate inventory status as the outcome of interest. Results: When viewed as a whole, the inventory of each test kit was reported as being at adequate levels more than 89% of the time across the 75 facilities. However, disaggregated analysis revealed significant variability in the inventory levels of HIV RDTs at the district level. Specifically, the districts of Inhassunge, Namacurra, and Pebane reported inadequate inventory levels (threatened + stockout), of one or both test kits, for more than 10% of the study period. In addition, a disparity between inventory levels of each test kit was identified, with the odds of reporting inadequate inventory levels of the confirmatory test (Uni-Gold™) being approximately 1.8-fold greater than the initial test (Determine™) (odds ratio: 1.82, 95% CI: 1.40-2.38). Conclusion: As Test and Treat programs evolve, a significant emphasis should be placed on the "test" component of the strategy, beginning with assurances that health facilities have the adequate inventory of RDT necessary to meet the needs of their community. As national policy-makers rely predominantly on data from the upstream arm of the supply chain, it is unlikely the disparity between inventory levels of HIV RDTs identified at individual districts and specific health facilities would have been recognized. Moving forward, our findings point to a need for (1) renewed efforts reinforcing appropriate downstream forecasting of essential medicines and diagnostic tests in general and for Uni-Gold™ test kits specifically, and (2) simple metrics that may be routinely collected at all health facilities and which may then easily and quickly flow upstream so that policy-makers may optimally allocate resources.
Highlights
Diagnostic testing is a cornerstone of public health efforts to detect infection and acts as the fundamental precursor to prevention, treatment, and disease management
An assessment of HIV rapid diagnostic test (RDT) inventories in Zambézia province, Mozambique was conducted revealing a disparity in inventory levels between the initial and confirmatory tests at the district and facility levels, a finding that would have been lost if based upon routine reporting standards which emphasize only composite reporting of provincial level stocks
Implications for the public Our assessment of rapid diagnostic tests (RDTs) in Zambézia province, Mozambique revealed a disparity in the inventory levels of initial and confirmatory HIV RDTs, a finding that has implications for patient outcomes and on the success of initiatives seeking to end the HIV/AIDS epidemic
Summary
Diagnostic testing is a cornerstone of public health efforts to detect infection and acts as the fundamental precursor to prevention, treatment, and disease management. The significance of diagnostic testing has been underscored by the Sustainable Development Goal of ending the HIV/AIDS epidemic by 2030.1,2 Efforts to achieve this goal are embodied by programs such as the World Health Organization’s “Testand-Treat” strategy, which advocates for all individuals who test positive for HIV being placed on life-long combination antiretroviral therapy (ART), regardless of their CD4+ cell count.[3,4] This proactive approach has been endorsed by the UNAIDS’ 90-90-90 initiative.[5] In an effort to reduce HIV to a low-level endemic disease, the 90-90-90 strategy seeks to have 90% of persons living with HIV (PLHIV) aware of their status by 2020; 90% of all individuals diagnosed with HIV placed on sustained ART; and 90% of individuals who have initiated ART achieving virologic suppression.[5,6] The success, or failure, of these ambitious programs rests upon the vast majority of PLHIV knowing their status, a pursuit which is incumbent upon accurate diagnostic testing. HIV RDTs have the benefit of providing results within 30 minutes, thereby allowing for testing, counseling, and referral to take place during a single visit.[10,11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
