Abstract
BackgroundIt is unknown to what extent the non-HIV population utilises laboratories supported by the President’s Emergency Plan for AIDS Relief (PEPFAR).ObjectivesWe aimed to describe the number and proportion of laboratory tests performed in 2009 and 2011 for patients referred from HIV and non-HIV services (NHSs) in a convenience sample collected from 127 laboratories supported by PEPFAR in Tanzania. We then compared changes in the proportions of tests performed for patients referred from NHSs in 2009 vs 2011.MethodsHaematology, chemistry, tuberculosis and syphilis test data were collected from available laboratory registers. Referral sources, including HIV services, NHSs, or lack of a documented referral source, were recorded. A generalised linear mixed model reported the odds that a test was from a NHS.ResultsA total of 94 132 tests from 94 laboratories in 2009 and 157 343 tests from 101 laboratories in 2011 were recorded. Half of all tests lacked a documented referral source. Tests from NHSs constituted 42% (66 084) of all tests in 2011, compared with 31% (29 181) in 2009. A test in 2011 was twice as likely to have been referred from a NHS as in 2009 (adjusted odds ratio: 2.0 [95% confidence interval: 2.0–2.1]).ConclusionBetween 2009 and 2011, the number and proportion of tests from NHSs increased across all types of test. This finding may reflect increased documentation of NHS referrals or that the laboratory scale-up originally intended to service the HIV-positive population in Tanzania may be associated with a ‘spillover effect’ amongst the general population.
Highlights
Investment in strengthening laboratory systems in resource-poor countries is critical to meet health needs across major diseases such as HIV/AIDS and to meet the United Nations Millennium Development Goals.[1]
The US government has invested over $15 billion in HIV prevention, care and treatment in low- and middle-income countries via the President’s Emergency Plan for AIDS Relief (PEPFAR).[2]. This support has included a wide range of activities aimed at strengthening health services, including laboratories, to provide services for persons living with HIV (PLWH)
Since 2006, PEPFAR has provided over $440 million to strengthen laboratory systems through improved infrastructure and equipment, human resources and training, quality improvement, and technical assistance.[8]. This investment has expanded laboratory services such as diagnostic and monitoring tests for PLWH. Because these laboratory investments support health facilities serving a broad population of patients, not just PLWH, it is plausible that they may have affected, or in the future could affect, the coverage and quality of laboratory services used by the general population – that is, individuals with no known HIV infection.[9]
Summary
Investment in strengthening laboratory systems in resource-poor countries is critical to meet health needs across major diseases such as HIV/AIDS and to meet the United Nations Millennium Development Goals.[1]. Since 2006, PEPFAR has provided over $440 million to strengthen laboratory systems through improved infrastructure and equipment, human resources and training, quality improvement, and technical assistance.[8] This investment has expanded laboratory services such as diagnostic and monitoring tests for PLWH. Because these laboratory investments support health facilities serving a broad population of patients, not just PLWH, it is plausible that they may have affected, or in the future could affect, the coverage and quality of laboratory services used by the general population – that is, individuals with no known HIV infection.[9] To our knowledge, no studies have explored this question yet. It is unknown to what extent the non-HIV population utilises laboratories supported by the President’s Emergency Plan for AIDS Relief (PEPFAR)
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