overcoming sample transportation challenges: using fedex to transport hiv early infant diagnosis...
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Overcoming sample transportation challenges: Using FedEx to transport HIV early
infant diagnosis (DBS) samples from hard to reach areas to a central lab in Zimbabwe
Tumbare, E; Mahomva, A; Mthombeni, PZiMA Annual Congress
Elephant HillsAugust 28, 2014
Acknowledgements
Outline
Background Context Description Lessons learnt Challenges Other innovations Conclusions and recommendations
Background-Zim stats Total population: 13mil
(2012) PLHIV: 1,4mil; of whom
156, 718 are children 0-14years*
Adult HIV prevalence 15%* ANC HIV prevalence
16.1%* MTCT rate: 18% (Spectrum 2011); 8.8% from 2012 survey
New pediatric HIV infections are estimated at 6,843* (90% from MTCT)
Adult need for ART (2014) 955 922 Peads needing ART
(2012): 100 561
Sour11 & MOHCW HIV estimates 2012
Background
Zimbabwe’s ART program reached near universal adult access in 2013
Only 44% of 46 000 children in need of ART receiving it
Efforts needed to scale up Peads ART
Disparity Between Adult and Pediatric ART Coverage continues
Making the case for early infant diagnosis
Zimbabwe expects delivery of more than 60,000 HIV-exposed infants annually who need early HIV diagnosis.
Approx. 50% of HIV-infected infants die before second birthday, if untreated
Early treatment is critical in averting both high morbidity and mortality in pediatric patients
EID is the most critical step in identifying infected infants and linking them to care
Context
Zimbabwe EID program depends on one National Microbiology Reference Laboratory (2nd laboratory opened only recently in Mutare)
Until a few months ago, NMRL was responsible for processing specimens from approximately 1,440 EID sites.
Sample
Result
Issues
Centralized set-up requires efficient transportation and results dissemination system
MTR of PMTCT (2013), TAT for EID- DBS specimen collection to delivering results - 54 days [7.7 weeks]
One of the biggest barriers to early HIV diagnosis is sample and result transportation
Innovative methods to transport samples particularly from hard to reach areas are critical
Description
EGPAF sought strategies to address sample transportation challenges
Courier Connect was contracted initially in 2011
Later FedEx took over in 2012 Samples collected from 217 central
collection points and delivered to NMRL Results returned using same route
Map with FedEx sample collection points
Description
EGPAF receives feedback on sample pick-up rates through DFPs stationed in the districts
Summary information is collected through tracking
Monthly meetings between EGPAF and FedEx are held to discuss progress and address challenges
Lessons learnt
FedEx couriers now routinely collect samples from 217 points, which serve as central collection points for over one thousand sites throughout the country
Average specimen transportation time from facility to laboratory has declined from 2 months pre-FedEx use to 2 weeks
Return of results to collection sites has been reduced from about four months to two weeks
Number of specimens processed through the national laboratory increased from 20,609 in 2010 to 55,240 in 2013
HIV DNA PCR TESTS BY YEAR: 2010-2013
Scale Up of Paediatric ART in Zimbabwe 2004-2012
Challenges
Main challenge has been reaching the very hard to reach sites with poor/none existent road networks
Batching of samples Delays also with sample processing
within the lab Limited human resource Breakdown of machines Reagent stock-outs
Delays in return of results to caregiver
Other innovations
Engagement of EHTs and use of integrated sample transportation system
Use of GPRS (50 sites) SMS technology (>1000 sites)
Decentralization of EID labs
NMRLMash West, Mash Central, Mash East, Harare, Midlands
Mutare lab
Manicaland,
Masvingo
Mpilo lab
Bulawayo, Mat North, Mat South
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Future innovations
Testing at birth HIV-related mortality peaks at around 2–3
months of age Virological testing at birth might allow ART
initiation before peak mortality occurs
Point of care EID
EID and the private practitioner
Most private practitioners use private labs for PCR
Referral of clients for DBS collection at municipal clinics possible
Staff can be trained to collect DBS samples and deliver to local clinic/lab
Either way- early identification of HIV infection critical for early initiation on ART
Use of dosing wheels as job aides (available at EGPAF stand)
Conclusions and recommendations
Courier system proven to be a viable method of scaling up EID sample and result transportation
Decentralization needs to continue to further shorten EID TAT
Well defined SOPs are required to ensure timely disbursement of EID results from facilities to clients’ care-givers.
Final thought…………
It always seems impossible until its done- Nelson Mandela