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