The integration of tuberculosis and HIV testing on GeneXpert can substantially improve access and same-day diagnosis and benefit tuberculosis programmes: A diagnostic network optimization analysis in Zambia
Open Access
- 25 January 2023
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS Global Public Health
- Vol. 3 (1), e0001179
- https://doi.org/10.1371/journal.pgph.0001179
Abstract
Diagnostic network optimization (DNO), a geospatial optimization technique, can improve access to diagnostics and reduce costs through informing policy-makers’ decisions on diagnostic network changes. In Zambia, viral load (VL) testing and early infant diagnosis (EID) for HIV has been performed at centralized laboratories, whilst the TB-programme utilizes a decentralized network of GeneXpert platforms. Recently, the World Health Organization (WHO) has recommended point-of-care (POC) EID/VL to increase timely diagnosis. This analysis modelled the impact of integrating EID/VL testing for children and pregnant/breastfeeding-women (priority-HIV) with TB on GeneXpert in Zambia. Using OptiDx, we established the baseline diagnostic network using inputs for testing demand (October 2019-September 2020), referrals, testing sites, testing platforms, and costs for HIV/TB testing (transport, test, device) respectively in Zambia. Next, we integrated priority-HIV testing on GeneXpert platforms, historically only utilized by the TB-programme. 228,265 TB tests were conducted on GeneXpert devices and 167,458 (99%) of priority-HIV tests on centralized devices at baseline, of which 10% were tested onsite at the site of sample collection. With integration, the average distance travelled by priority-HIV tests decreased 10-fold (98km to 10km) and the proportion tested onsite increased (10% to 48%). 52% of EID tests are likely to be processed within the same-day from a baseline of zero. There were also benefits to the TB-programme: the average distance travelled/specimen decreased (11km to 7km), alongside potential savings in GeneXpert device-operating costs (30%) through cost-sharing with the HIV-programme. The total cost of the combined testing programmes reduced marginally by 1% through integration/optimization. DNO can be used to strategically leverage existing capacity to achieve the WHO’s recommendation regarding POC VL/EID testing. Through DNO of the Zambian network, we have shown that TB/HIV testing integration can improve the performance of the diagnostic network and increase the proportion of specimens tested closer to the patient whilst not increasing costs.Funding Information
- Bill and Melinda Gates Foundation (OPP1203377)
This publication has 9 references indexed in Scilit:
- The cost-effectiveness of scaling-up rapid point-of-care testing for early infant diagnosis of HIV in southern ZambiaPLOS ONE, 2021
- Updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring2021
- Evaluation of near point‐of‐care viral load implementation in public health facilities across seven countries in sub‐Saharan AfricaJournal of the International AIDS Society, 2021
- Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and DefinitionsDiagnostics, 2020
- Modeling the cost-effectiveness of point-of-care platforms for infant diagnosis of HIV in sub-Saharan African countriesAIDS, 2020
- Building and Sustaining Optimized Diagnostic Networks to Scale-up HIV Viral Load and Early Infant DiagnosisJAIDS Journal of Acquired Immune Deficiency Syndromes, 2020
- Economic and public health impact of decentralized HIV viral load testing: A modelling study in KenyaPLOS ONE, 2019
- Multidisease testing for HIV and TB using the GeneXpert platform: A feasibility study in rural ZimbabwePLOS ONE, 2018
- Practical recommendations for strengthening national and regional laboratory networks in Africa in the Global Health Security eraAfrican Journal of Laboratory Medicine, 2016