Viral load scale-up optimization: South Africa (Completed)

The South African National Health Laboratory Service (NHLS) is the largest diagnostic pathology service provider in South Africa. Through a national network of laboratories, it is responsible for supporting the national and provincial health departments in the delivery of healthcare. NHLS currently utilizes a courier network for the transportation of specimens from healthcare facilities to laboratories. Couriers collect specimens from the facilities at least once per day and more frequently at the high volume facilities. The NHLS sought ways in which to improve service coverage, increase efficiency and improve patient outcomes, with particular regard to viral load testing, one of the most commonly requested laboratory-based diagnostics in South Africa.

Motor vehicles are utilized for the transportation of specimens. Transportation, however, remains largely restricted by political boundaries and as such a model is required to optimize service coverage, turnaround times, and cost at a national level. We aimed to reduce specimen turnaround times through geospatial optimization, remove political boundaries for more efficient vehicle routine, and determine optimal sample pathways.  The project also identified optimal placement of point of care instruments for viral load monitoring to improve patient outcomes and reduced turnaround time at minimal additional cost.

Girdwood S, Crompton T, Sharma M, Dorward J, Garrett N, Drain PK, Stevens W, Nichols BE. Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa. EClinicalMedicine. 2020 Nov 4;28:100607.