Method for Selection of Laboratories in Need of Infrastructure Improvement to Meet HIV Viral Load and Early Infant Diagnosis Unmet Testing Needs in Kenya
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 11, Issue 5
Abstract
Introduction: Laboratory infrastructure remains an obstacle for meeting ISO 15189 requirements to assure functional quality management system essentials and competency to generate accurate results. With limited resources, it is challenging to select which facilities to upgrade from among many of similar needs. While common variables in laboratory systems are known, a model that uses these variables to identify priority laboratories for infrastructure upgrade in most resource limited setting is missing. Methods: A quantitative and qualitative based questionnaire was used to collect specific indicators. Principal Component Analysis (PCA) type of factor analysis was then used to generate weights for each indicator. Composite indices were then obtained and used to group laboratories into four ranked clusters. Results: Four clusters were generated in ranked order where the poorest performing facilities n=4, 21.1% were classified in cluster one. Of the 29 indicators the composite range score for the first five was 0.083-0.142. Absence of fire and smoke detectors had the least weight at -0.13. Among the 20 laboratories 9 had a negative factor weight. Discussion: PCA method provides an opportunity to apply quantitative methods for generating weights that can be applied to select laboratories for infrastructure improvement. Introduction Capabilities of medical laboratories in sub-Saharan Africa vary depending on the country, development partners and location [1]. Common variables considered in ranking laboratory systems in this region are: laboratory infrastructure, laboratory equipment, supplies management system, access to utilities and implementation of quality management system [2,3]. Investment to support HIV, TB and malaria diagnosis have been geared towards improving quality management systems in service delivery rather than addressing infrastructural needs urgently required by these facilities, resulting in non-holistic response to priority diseases [4]. Kenya governance structures have devolved healthcare to the county governments which are yet to establish economic investment models for funding laboratory infrastructure [5]. The most missed variable in laboratory system investment is usually infrastructure. Allocating funds towards laboratory infrastructure upgrades are thus a challenge for laboratories to attain ISO 15189 accreditation in order to support key laboratory programs such as HIV and TB [6-9]. In order to overcome the challenges and delivery of efficient specialized diagnostic services in support of priority disease (HIV, TB and Malaria), Kenya has adopted the use of selected public health and research laboratories. Due to this, a significant success in terms of VL/EID coverage has been noted [10-12]. This can be attributed to laboratory implementing partners. Despite these improvements, VL/EID test access in remote locations in Kenya is still restricted due to high costs, complex specimen collection and transport requirements, need for well-established laboratory infrastructure and well-trained personnel [13,14]. In June 2013, World Health Organization (WHO) recommended routine viral load monitoring as the preferred strategy for the diagnosis and confirmation of antiretroviral therapy (ART) treatment failure (WHO 2013) [8,9,15-17]. This increased workload has resulted in long laboratory turnaround times with median values across the testing laboratories ranging from 12 days to 32 days [13]. Delayed detection of treatment failure and late HIV-1 infant diagnosis leads to accumulation of HIV drug resistance and costly switches to second-line ART [14].
Authors and Affiliations
Leonard Kingwara, Kipkerich Bera, Vincent Were, John Gituma, Franc Onyambu, Nancy Bowen, Emilia Fernandez, Dardane Arifaj Blumi
Keywords
Related Articles
- EP ID EP586988
- DOI 10.26717/BJSTR.2018.11.002168
- Views 209
- Downloads 0
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