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. 2023 May 15;12(1):2085.
doi: 10.4102/ajlm.v12i1.2085. eCollection 2023.

Modelling CD4 reagent usage across a national hierarchal network of laboratories in South Africa

Naseem Cassim  1   2 , Lindi-Marie Coetzee  1   2 , Deborah K Glencross  1
Affiliations

Modelling CD4 reagent usage across a national hierarchal network of laboratories in South Africa

Naseem Cassim et al. Afr J Lab Med. .

Abstract

Background: The National Health Laboratory Service is mandated to deliver cost-effective and efficient diagnostic services across South Africa. Their mandate is achieved by a network of laboratories ranging from centralised national laboratories to distant rural facilities.

Objective: This study aimed to establish a model of CD4 reagent utilisation as an independent measure of laboratory efficiency.

Methods: The efficiency percentage was defined as finished goods (number of reportable results) over raw materials (number of reagents supplied) for 47 laboratories in nine provinces (both anonymised) for 2019. The efficiency percentage at national and provincial levels was calculated and compared to the optimal efficiency percentage derived using pre-set assumptions. Comparative laboratory analysis was conducted for the provinces with the best and worst efficiency percentages. The possible linear relationship between the efficiency percentage and call-outs, days lost, referrals, and turn-around time was assessed.

Results: Data are reported for 2 806 799 CD4 tests, with an overall efficiency percentage of 84.5% (optimal of 84.98%). The efficiency percentage varied between 75.7% and 87.7% between provinces, while within the laboratory it ranged from 66.1% to 111.5%. Four laboratories reported an efficiency percentage ranging from 67.8% to 85.7%. No linear correlation was noted between the efficiency percentage, call-outs, days lost, and turn-around time performance.

Conclusion: Reagent efficiency percentage distinguished laboratories into different utilisation levels irrespective of their CD4 service level. This parameter is an additional independent indicator of laboratory performance, with no relationship with any contributing factors tested, that can be implemented across pathology disciplines for monitoring reagent utilisation.

What this study adds: This study provides an objective methodology to assess reagent utilisation as an independent measure of laboratory efficiency. This model could be applied to all routine pathology services.

Keywords: CD4; HIV; efficiency; laboratory; reagents.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Bubble chart assessing provincial CD4 reagent utilisation of nine provinces in South Africa for 2019. The efficiency percentage, percentage of samples that met the turn-around time target, and raw materials cost (United States dollars) are reported on the x-axis, y-axis, and as bubble size.
FIGURE 2
FIGURE 2
CD4 reagent utilisation of 47 laboratories across nine provinces in South Africa for 2019.
FIGURE 3
FIGURE 3
Correlation of CD4 reagent use efficiency of 47 laboratories in South Africa for 2019. Efficiency is plotted with (a) the number of call-outs, (b) the number of days lost, (c) the percentage of referrals, and (d) turn-around time performance.
See this image and copyright information in PMC

References

    1. National Health Laboratory Service (NHLS) . Annual report 2018/19 Johannesburg, South Africa [homepage on the Internet]: National Health Laboratory Service (NHLS). 2019. [cited 2020 Feb 19]. Available from: https://www.nhls.ac.za/key-documents/annual-reports/
    1. National Department of Health (NDOH) . ART clinical guidelines for the management of HIV in adults, pregnancy, adolescents, children, infants and neonates Pretoria, South Africa [homepage on the Internet]: National Department of Health (NDOH). 2019. [cited 2020 Jan 18]. Available from: https://www.knowledgehub.org.za/system/files/elibdownloads/2020-05/2019%...
    1. World Health Organization (WHO) . Consolidated HIV guidelines for prevention, treatment, service delivery & monitoring: Recommendations for a public health approach [homepage on the Internet]. 2021. [cited 2022 Aug 17]. Available from: https://apps.who.int/iris/rest/bitstreams/1357089/retrieve - PubMed
    1. Glencross DK, Coetzee LM, Cassim N. An integrated tiered service delivery model (ITSDM) based on local CD4 testing demands can improve turn-around times and save costs whilst ensuring accessible and scalable CD4 services across a national programme. PLoS One. 2014;9(12):e114727. 10.1371/journal.pone.0114727 - DOI - PMC - PubMed
    1. Cassim N, Coetzee LM, Schnippel K, Glencross DK. Estimating implementation and operational costs of an integrated tiered CD4 service including laboratory and point of care testing in a remote health district in South Africa. PLoS One. 2014;9(12):e115420. 10.1371/journal.pone.0115420 - DOI - PMC - PubMed

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