Lessons from the Field

Strategic site selection for placement of HIV early infant diagnosis point-of-care technology within a national diagnostic network in Lesotho

Anafi Mataka, Esther A.J. Tumbare, Tsietso Motsoane, David Holtzman, Monkoe Leqheka, Kolisang Phatsoane, Emma Sacks, Anthony Isavwa, Appolinaire Tiam
African Journal of Laboratory Medicine | Vol 10, No 1 | a1156 | DOI: https://doi.org/10.4102/ajlm.v10i1.1156 | © 2021 Anafi Mataka, Esther Tumbare, Tsietso Motsoane, David Holtzman, Monkoe Leqheka, Kolisang Phatsoane, Emma Sacks, Anthony Isavwa, Appolinaire Tiam | This work is licensed under CC Attribution 4.0
Submitted: 23 December 2019 | Published: 24 August 2021

About the author(s)

Anafi Mataka, African Society for Laboratory Medicine, Addis Ababa, Ethiopia
Esther A.J. Tumbare, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Maseru, Lesotho
Tsietso Motsoane, Laboratory Services, Ministry of Health, Maseru, Lesotho
David Holtzman, Partners in Health, Maseru, Lesotho
Monkoe Leqheka, Laboratory Services, Ministry of Health, Maseru, Lesotho
Kolisang Phatsoane, Laboratory Services, Ministry of Health, Maseru, Lesotho
Emma Sacks, School of Public Health, George Washington University, Washington, District of Columbia, United States
Anthony Isavwa, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Nairobi, Kenya
Appolinaire Tiam, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Washington, District of Columbia, United States


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Abstract

Background: New 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.

Intervention: Lesotho 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 learnt: After 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.

Recommendations: POC 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.


Keywords

HIV early infant diagnosis; point-of-care; increased health access; site selection

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