EID Point of Care Testing improves access and turn-around-times.

INTRODUCTION

This dissertation aims at understanding the patient impact of implementing Point of Care (POC) EID technologies on access and test turnaround times. Diagnosis of HIV in infants is a complex process requiring multiple post-partum visits from mother/infant pairs and expensive nucleic acid amplification tests (NAAT). The use of NAATs is strongly recommended by the WHO for diagnosis in infants, but these assays are typically performed by highly trained personnel using specialized laboratory equipment, limiting access in many high burden counties to centralized urban facilities.

METHODS

Pre-post intervention design was employed whereby Pre-intervention conventional EID data collected retrospectively from the EID register from November 2015 to march 2016 while Post-intervention data for specimens processed between November 2018 and March 2019 collected prospectively using a POC EID testing form. The median turn-around-time (TAT) and accessibility (total number of tests done) compared between conventional and Point of Care (POC) EID.

RESULTS

From the data collected, in the period November 2015 to March 2016, the total EID tests done were 347. During this period, conventional method was the mode of testing. Averagely, there were no results received on the same day. From analysis, 6.3% of the results were received between 1-7 days, 78.7% between 8-30 days and 15% of the results taking more than 30 days. After implementation of POC EID technology by Alere q (a fully automated nucleic acid testing platform i.e. on the spot real-time polymerase chain reaction (PCR)) there was a remarkable increase in total tests done in the period of November 2018 to march 2019. The total tests done were 928, out of these, 3.99% of the results were received on the same day, 96.01% received between 1-7 days with no result being received later than 8 days.

CONCLUSION

The use of Point of Care EID technology has greatly improved the test turn-around-times which encourages rapid clinical decision making as well as test availability and accessibility by eliminating long distance transportation to conventional laboratories. From a health systems perspective, POC EID testing has the potential to circumvent many of the logistical challenges in the existing systems and being a time-bound intervention that requires rapid clinical decision making, its integration into the current system would allow for wider access to EID testing and improve patient outcomes. It is also a great input to the attainment of global 90-90-90 targets.