Abstract
BackgroundThe surge of donor funds to fight HIV&AIDS epidemic inadvertently resulted in the setup of laboratories as parallel structures to rapidly respond to the identified need. However these parallel structures are a threat to the existing fragile laboratory systems. Laboratory service integration is critical to remedy this situation. This paper describes an approach to quantitatively measure and track integration of HIV-related laboratory services into the mainstream laboratory services and highlight some key intervention steps taken, to enhance service integration.MethodA quantitative before-and-after study conducted in 122 Family Health International (FHI360) supported health facilities across Nigeria. A minimum service package was identified including management structure; trainings; equipment utilization and maintenance; information, commodity and quality management for laboratory integration. A check list was used to assess facilities at baseline and 3 months follow-up. Level of integration was assessed on an ordinal scale (0 = no integration, 1 = partial integration, 2 = full integration) for each service package. A composite score grading expressed as a percentage of total obtainable score of 14 was defined and used to classify facilities (≤80% FULL, 25% to 79% PARTIAL and <25% NO integration). Weaknesses were noted and addressed.ResultsWe analyzed 9 (7.4%) primary, 104 (85.2%) secondary and 9 (7.4%) tertiary level facilities. There were statistically significant differences in integration levels between baseline and 3 months follow-up period (p<0.01). Baseline median total integration score was 4 (IQR 3 to 5) compared to 7 (IQR 4 to 9) at 3 months follow-up (p = 0.000). Partial and fully integrated laboratory systems were 64 (52.5%) and 0 (0.0%) at baseline, compared to 100 (82.0%) and 3 (2.4%) respectively at 3 months follow-up (p = 0.000).DiscussionThis project showcases our novel approach to measure the status of each laboratory on the integration continuum.
Highlights
Despite the pivotal role of laboratory services in the health care system, it has been grossly neglected in Africa over the decades [1], [2]
The study was conducted in 122 FHI360 supported facilities covering all the 36 states in Nigeria including the Federal Capital Territory (FCT) (Figure 1)
64 (52.5%) facilities laboratory systems were partially integrated, while no (0.0%) facility was fully integrated at baseline, compared to 100 (82.0%) partial integration and 3 (2.4%) full integration at 3 months follow up (p = 0000) (TABLE 2)
Summary
Despite the pivotal role of laboratory services in the health care system, it has been grossly neglected in Africa over the decades [1], [2]. The integration of public health laboratories within clinical programs serving both those with HIV and the general public is essential [3] The surge of donor funds to fight HIV&AIDS epidemic inadvertently resulted in the setup of laboratories as parallel structures to rapidly respond to the identified need. These parallel structures are a threat to the existing fragile laboratory systems. This paper describes an approach to quantitatively measure and track integration of HIV-related laboratory services into the mainstream laboratory services and highlight some key intervention steps taken, to enhance service integration
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