Exploring the delays in turnaround time for HIV early infant diagnosis in selected health facilities in Zimbabwe
Background: Early infant diagnosis (EID) is critical to the health and survival of HIV-exposed infants. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has been supporting a courier to transport EID specimens and results between central collection points and processing laboratories since 2011.Until 2013, Zimbabwe had one EID laboratory, the National Microbiology Reference Laboratory (NMRL), to process specimens from around 1,440 sites. In 2014, EID testing was decentralized to two more regional laboratories in Mutare and Bulawayo cities, with EGPAF and other partners'' support. EGPAF conducted an assessment of turn-around time (TAT) and causes of delay in the EID program.
Methods: A cross-sectional descriptive study was conducted in 23 health facilities, randomly selected from 7 provinces including 9 peripheral and 14 courier collection sites. EID TAT data was collected for 1,557 EID dried blood spot (DBS) samples collected between June and November 2014. Qualitative data were collected through key informant interviews with EID service providing health care workers. The TAT was time from date of specimen collection to date of delivering results to a client. Data were analyzed using Epi-Info. The study was approved by the Medical Research Council of Zimbabwe.
Results: Approximately 40% (627/1,557) of specimens assessed had complete TAT data. Overall national level TAT was 10.1 weeks against a 4 weeks standard. Specimens processed at the NMRL had the highest median TAT (13.5 weeks) compared to regional laboratories (TAT = 4.9 weeks and 4.4weeks, respectively). The longest delay in TAT was in the laboratories; the NMRL (original EID lab) contributing the most to this delay with 7.4 weeks internal TAT. Urban healthcare facilities had higher TAT (11.1 weeks) compared to rural healthcare facilities (8weeks) p=0.02. Clinics had higher TAT (11.7 weeks) compared to hospitals (7 weeks), p=0.000. Hospitals have more referral clients who take longer to collect results.
| EID Process | Median TAT in weeks | Lower and Upper Quartiles | EID Process | Median TAT in weeks | Lower and Upper Quartiles | EID Process | Median TAT in weeks | Lower and Upper Quartiles |
| Crude Overall TAT (n=627) | 10.1 | (5.1; 13.9) | EID process stage (National) | Type of Facility (p<0.001) | ||||
| EID TAT by processing laboratory | Collecting site to courier pick-up | 0.86 | (0.0; 1.37) | Hospital | 7.0 | (4.0; 12.8) | ||
| National Medical Reference Laboratory (n=338) | 13.5 | (11.7; 16.7) | Courier pick-up to receipt at lab | 1.28 | (0.8; 2.2) | Clinic | 11.7 | (6.3; 15.0) |
| Mutare Provincial Hospital Laboratory (n=280) | 4.9 | (4.0; 7.4) | Lab receipt to lab testing | 6.1 | (1.9; 7.1) | |||
| Mpilo Provincial Hospital Laboratory (n=9) | 4.4 | (4.0; 5.0) | Testing to dispatch from lab | 0.4 | (0.1; 0.7) | |||
| Rural/Urban Setting (p=0.02) | Dispatch from lab to courier delivery point | 1.4 | (0.3; 6.4) | |||||
| Urban | 11.1 | (4.9; 14.8) | From Courier delivery point to collecting site | 0.14 | (0.1; 26.6) | |||
| Rural | 8.2 | (5.2; 12.9) | Receipt at site to client given | 2.0 | (0.8; 4.2) | |||
Conclusions: Overall TAT in the national EID program remains far too long. The courier system and decentralization of EID have reduced TAT in the provinces served by regional labs. EGPAF is in process of working with MOHCC to further decentralize EID process and have more sites referring specimens to the regional laboratories.
R. Musarandega1, B. Mutede1, A. Muchedzi1, T. Moga1, C. Muchuchuti1, A. Chadambuka1, T. Ncomanzi1, T. Nyamundaya1, K. Maeka2
1Elizabeth Glaser Pediatric AIDS Foundation, Technical Department, Harare, Zimbabwe, 2National Microbiology Reference Laboratory, Ministry of Health and Child Care, Harare, Zimbabwe