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
Open Access
- 9 December 2014
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 9 (12), e114727
- https://doi.org/10.1371/journal.pone.0114727
Abstract
The South African National Health Laboratory Service (NHLS) responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART), has demanded extending CD4 services to meet increasing clinical needs. The aim of this study was to review existing services and develop a service-model that integrated laboratory-based and point-of-care testing (POCT), to extend national coverage, improve local turn-around/(TAT) and contain programmatic costs. NHLS Corporate Data Warehouse CD4 data, from 60–70 laboratories and 4756 referring health facilities was reviewed for referral laboratory workload, respective referring facility volumes and related TAT, from 2009–2012. An integrated tiered service delivery model (ITSDM) is proposed. Tier-1/POCT delivers CD4 testing at single health-clinics providing ART in hard-to-reach areas (than R125 million in HIV/AIDS programmatic costs. ITSDM hierarchical parental-support also assures laboratory/POC management, equipment maintenance, quality control and on-going training between tiers.This publication has 15 references indexed in Scilit:
- Feasibility of Performing Multiple Point of Care Testing for HIV Anti-Retroviral Treatment Initiation and Monitoring from Multiple or Single FingersticksPLOS ONE, 2013
- Rapid Point-of-Care CD4 Testing at Mobile HIV Testing Sites to Increase Linkage to CareJAIDS Journal of Acquired Immune Deficiency Syndromes, 2012
- How to Estimate the Cost of Point-of-Care CD4 Testing in Program Settings: An Example Using the Alere Pima™ Analyzer in South AfricaPLOS ONE, 2012
- Performance evaluation of the Pima™ point‐of‐care CD4 analyser using capillary blood sampling in field tests in South AfricaJournal of the International AIDS Society, 2012
- Providing Immediate CD4 Count Results at HIV Testing Improves ART InitiationJAIDS Journal of Acquired Immune Deficiency Syndromes, 2011
- Effect of point-of-care CD4 cell count tests on retention of patients and rates of antiretroviral therapy initiation in primary health clinics: an observational cohort studyThe Lancet, 2011
- A Shifting Paradigm in Strengthening Laboratory Health Systems for Global HealthAmerican Journal of Clinical Pathology, 2010
- Early loss to follow up after enrolment in pre‐ART care at a large public clinic in Johannesburg, South AfricaTropical Medicine & International Health, 2010
- A model for continuous quality control incorporating sample‐to‐sample assessment of optical alignment, fluorescence sensitivity, and volumetric operation of flow cytometersCytometry Part B: Clinical Cytometry, 2010
- CD45‐assisted PanLeucogating for accurate, cost‐effective dual‐platform CD4+ T‐cell enumerationCytometry, 2002