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. 2013 Nov 13;8(11):e78609.
doi: 10.1371/journal.pone.0078609. eCollection 2013.

Uganda's new national laboratory sample transport system: a successful model for improving access to diagnostic services for Early Infant HIV Diagnosis and other programs

Charles Kiyaga  1 , Hakim Sendagire, Eleanor Joseph, Ian McConnell, Jeff Grosz, Vijay Narayan, Godfrey Esiru, Peter Elyanu, Zainab Akol, Wilford Kirungi, Joshua Musinguzi, Alex Opio
Affiliations

Uganda's new national laboratory sample transport system: a successful model for improving access to diagnostic services for Early Infant HIV Diagnosis and other programs

Charles Kiyaga et al. PLoS One. .

Abstract

Introduction: Uganda scaled-up Early HIV Infant Diagnosis (EID) when simplified methods for testing of infants using dried blood spots (DBS) were adopted in 2006 and sample transport and management was therefore made feasible in rural settings. Before this time only 35% of the facilities that were providing EID services were reached through the national postal courier system, Posta Uganda. The transportation of samples during this scale-up, therefore, quickly became a challenge and varied from facility to facility as different methods were used to transport the samples. This study evaluates a novel specimen transport network system for EID testing.

Methods: A retrospective study was done in mid-2012 on 19 pilot hubs serving 616 health facilities in Uganda. The effect on sample-result turnaround time (TAT) and the cost of DBS sample transport on 876 sample-results was analyzed.

Results: The HUB network system provided increased access to EID services ranging from 36% to 51%, drastically reduced transportation costs by 62%, reduced turn-around times by 46.9% and by a further 46.2% through introduction of SMS printers.

Conclusions: The HUB model provides a functional, reliable and efficient national referral network against which other health system strengthening initiatives can be built to increase access to critical diagnostic and treatment monitoring services, improve the quality of laboratory and diagnostic services, with reduced turn-around times and improved quality of prevention and treatment programs thereby reducing long-term costs.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The various methods previously used in transportation of specimen.
Figure 2
Figure 2. The recommended turnaround time measured as the time from collection of a sample to receipt of the results was about 28
Figure 3
Figure 3. Estimated costs different aspects of sample analysis.
Figure 4
Figure 4. The local network that is covered by each bike.
Figure 5
Figure 5. The cost in 2010 before the network was started compared to when additional costs for start up of the transport network were added.
Figure 6
Figure 6. The projected 4 year costs once the transport network is established.
Figure 7
Figure 7. The cost at each of the 19 hubs before and after the initiation of the National sample referral transport network (NSRTN).
Figure 8
Figure 8. How Turnaround Time reduced; sample and result transit time dropped from 49 days before lab consolidation to 26 day and from 26 to 14 days due to the NSRTN.
Figure 9
Figure 9. Turnaround times for the facilities before the introduction of the transport network in July 2011.
The recommended turnaround time measured as the time from collection of a sample to receipt of the results was about 28
See this image and copyright information in PMC

References

    1. UN General Assembly(2011) Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS. UNAIDS.
    1. Ministry of Health-Uganda (2012) HIV/AIDS Indicator Survey.
    1. Aledort JE Ronald A Le Blancq SM Ridzon R Landay A et al. (2006) Reducing the burden of HIV/AIDS in infants: the contribution of improved diagnostics. Nature, 444 Suppl 1: p. 19–28. - PubMed
    1. Ministry of Health-Uganda (2010) National Health Facility Inventory.
    1. Creek T, Tanuri A, Smith M, Seipone L, Smit M, et al. (2008) Early diagnosis of human immunodeficiency virus in infants using polymerase chain reaction on dried blood spots in Botswana's national program for prevention of mother-to-child transmission. Pediatr Infect Dis J,. 27(1): p. 22–6. - PubMed

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