Lab Matters Fall 2017 | Page 23

global health

By Lydia Tongowona, laboratory mentor, APHL Zimbabwe Trust; Levi Vere, laboratory quality monitoring manager, APHL Zimbabwe Trust; Sadaf Chaudhry, manager, Global Health; and Haley Rademacher, associate specialist, Global Health

APHL, working with Ministry of Health and Child Care in Zimbabwe, has launched a new specimen transport system to strengthen the country’ s viral load( VL) testing. The new transport system supports implementation of a national five-year HIV VL testing plan created to help the country meet UNAID’ s 90-90-90 target. The ambitious plan aims to achieve 40 % VL coverage for patients on HIV treatment in 2017.

APHL began in 2016 by deploying VL testing platforms at six provincial laboratories across the country. Because the platforms use blood plasma for testing, it became crucial to deliver high quality whole blood specimens that had been stored and transported properly in the required cold chain. As demand for VL testing services increased with the testing ramp-up, it became clear that Zimbabwe needed an efficient and effective system that could transport specimens from point-of-care sites to VL testing laboratories within 24 hours.

“ Hub-and-Spoke” Model

APHL and its Zimbabwean partners developed a“ hub-and-spoke” specimen transport system model covering all health facilities supported by PEPFAR, including 585 priority sites in 36 of the country’ s 60 districts. Level II laboratories at district hospitals in the 36 districts serve as the“ hubs” of the system. They receive whole blood samples from nearby point-of-care sites, and prepare and store samples before forwarding them to a provincial VL laboratory. Point-of-care sites at clinics and rural health centers in the districts act as the“ spokes.”

This“ hub-and-spoke” system has brought laboratory capacity closer to sample collection sites, allowing specimens to be delivered to a laboratory that can process them within 24 hours of collection. As an added benefit, APHL has established laboratory quality management systems at 25 of the 36 hubs.

Motorbikes Increase Access to Testing

Each hub laboratory receives a mentorship visit to identify capacity and needs, define acceptance and rejection criteria for viral load samples, and implement information systems for accurate maintenance of specimen referral information. The laboratory also receives a motorbike used to pick up specimens from point-of-care sites. Motorbike riders receive fuel, uniforms, registration and licensing, comprehensive insurance, and payment for time spent in transport, as well as support for maintenance and servicing of the vehicles.

Remarkable Results in Less than a Year

Deployment of the new specimen transport system has shown remarkable results. In less than a year, over 90 % of the PEPFAR priority sites have transported VL samples to their nearest provincial laboratory; VL testing has increased from around 5 % to over 35 % of patients in PEPFAR priority districts, and the rejection rate for samples has stabilized below 2 % across all sites. n

In less than a year, over 90 % of the PEPFAR priority sites have transported VL samples to their nearest provincial laboratory; VL testing has increased from around 5 % to over 35 % of patients in PEPFAR priority districts, and the rejection rate for samples has stabilized below 2 % across all sites.”

APHL mentor Lydia Tongowona( left) hands over a motorbike to transport officer Richman Mleya of Matebeleland North Province