Abstract
BackgroundNew technologies for rapid point-of-care (POC) diagnostic tests hold great potential for improving the health outcomes of HIV-exposed infants. POC testing for HIV early infant diagnosis (EID) was introduced in Lesotho in late 2016. Here we highlight critical requirements for selecting routine POC EID sites to ensure a sustainable and optimised EID diagnostic network.InterventionLesotho introduced POC EID in a phased approach that included assessments of national databases to identify sites with high test volumes, the creation of local networks of sites to potentially increase access to POC EID, and a standardised capacity assessment to determine site readiness. Potential site networks comprising ‘hub’ testing sites and ‘spoke’ specimen referring sites were created.Lessons learntAfter determining optimal placement, a total of 29 testing facilities were selected for placement of POC EID to potentially increase access to 189 facilities through the use of a hub-and-spoke model. Site capacity assessments identified vital human resources and infrastructure capacity gaps that needed to be addressed before introducing POC EID and informed appropriate POC platform selection.RecommendationsPOC placement involves more than just purchasing the testing platforms. Considering the relatively small proportion of sites that can be eligible for placement of a POC platform, utilising a hub-and-spoke model can maximise the number of health facilities served by a POC platform while reducing the necessary capacity building and infrastructure investments to fewer sites.
Highlights
New technologies for rapid point-of-care (POC) diagnostic tests hold great potential for improving the health outcomes of HIV-exposed infants
In Lesotho, a country with a high burden of HIV infection of nearly one in every four pregnant women and adults aged between 15 years and 49 years,[1] antenatal care and HIV treatment for women and children are delivered at three levels: primary, secondary and tertiary
The dried blood spot (DBS) samples were transported from various health facilities all over the country to the National Reference Laboratory (NRL) using a motorcycle-based national sample transport system
Summary
In Lesotho, a country with a high burden of HIV infection of nearly one in every four pregnant women and adults aged between 15 years and 49 years,[1] antenatal care and HIV treatment for women and children are delivered at three levels: primary, secondary and tertiary. Return of paper-based results to clinics through the same sample transport system before reaching caregivers, who may not have telephone access to facilitate quicker result communication or live far from facilities To strengthen this centralised system, the Ministry of Health has implemented mechanisms such as routine training on DBS collection to ensure the quality of specimens and reduce rejection rates and provision of more motorcycles to increase the pick-up frequency of DBS and other clinical samples from facilities; many challenges remain. New technologies for rapid, point-of-care (POC) molecular diagnostic tests hold great potential for improving timely management of infants with HIV infection by eliminating delays in the return of results and enabling rapid initiation of antiretroviral therapy.[4,5] Lesotho embraced POC EID testing in 2016, making it one of the first countries to introduce the technology into routine clinical settings. This article aims to share Lesotho’s experiences of a systematic approach to identifying and assessing the readiness of potential POC EID sites and to highlight the critical requirements for selecting sites to integrate routine POC EID into a sustainable and optimised EID diagnostic network
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