Laboratory Diagnostics Market in East Africa: A Survey of Test Types, Test Availability, and Test Prices in Kampala, Uganda.

Lee F Schroeder,J Brooks Jackson,Timothy K Amukele,Ali Elbireer,Madhukar Pai

doi:10.1371/journal.pone.0134578

Abstract

BackgroundDiagnostic laboratory tests are routinely defined in terms of their sensitivity, specificity, and ease of use. But the actual clinical impact of a diagnostic test also depends on its availability and price. This is especially true in resource-limited settings such as sub-Saharan Africa. We present a first-of-its-kind report of diagnostic test types, availability, and prices in Kampala, Uganda.MethodsTest types (identity) and availability were based on menus and volumes obtained from clinical laboratories in late 2011 in Kampala using a standard questionnaire. As a measure of test availability, we used the Availability Index (AI). AI is the combined daily testing volumes of laboratories offering a given test, divided by the combined daily testing volumes of all laboratories in Kampala. Test prices were based on a sampling of prices collected in person and via telephone surveys in 2015.FindingsTest volumes and menus were obtained for 95% (907/954) of laboratories in Kampala city. These 907 laboratories offered 100 different test types. The ten most commonly offered tests in decreasing order were Malaria, HCG, HIV serology, Syphilis, Typhoid, Urinalysis, Brucellosis, Stool Analysis, Glucose, and ABO/Rh. In terms of AI, the 100 tests clustered into three groups: high (12 tests), moderate (33 tests), and minimal (55 tests) availability. 50% and 36% of overall availability was provided through private and public laboratories, respectively. Point-of-care laboratories contributed 35% to the AI of high availability tests, but only 6% to the AI of the other tests. The mean price of the most commonly offered test types was $2.62 (range $1.83–$3.46).InterpretationOne hundred different laboratory test types were in use in Kampala in late 2011. Both public and private laboratories were critical to test availability. The tests offered in point-of-care laboratories tended to be the most available tests. Prices of the most common tests ranged from $1.83-$3.46.

Highlights

The impact of a laboratory test on health outcomes depends on characteristics that are intrinsic to the test such as its diagnostic accuracy, complexity, and result interpretability
Test menus and daily laboratory-wide test volumes were obtained from 95% (907/954) of the laboratories identified in Kampala city
It shows the average price of these tests in Kampala in Ugandan shillings and U.S dollars, and the price of similar tests in the United States as determined by Center for Medicare and Medicaid Services clinical laboratory fee schedule.[18]

Summary

Background

Diagnostic laboratory tests are routinely defined in terms of their sensitivity, specificity, and ease of use. The actual clinical impact of a diagnostic test depends on its availability and price. This is especially true in resource-limited settings such as sub-Saharan Africa. We present a first-of-its-kind report of diagnostic test types, availability, and prices in Kampala, Uganda

Methods

Findings

Introduction

Results

Discussion