Improving the clinic-laboratory-interface in the context of HIV diagnosis, treatment, and monitoring.

PURPOSE OF REVIEW

Laboratory support is central to clinical medicine. The present review focuses on the health systems strengthening needs of the clinic-laboratory-interface (CLI) in developing countries within the context of HIV diagnosis, treatment, and monitoring.

RECENT FINDINGS

Although significant improvements have been made in reducing error rates in the analytical phase of pathology services within laboratories, there remain substantial deficits in both the preanalytic and postanalytic phases of the entire value chain that require strengthening. Recent interventions have largely aimed at improving the CLI focus through technological advancements. Although these are important, addressing CLI deficiencies within the context of the World Health Organization's health systems strengthening building blocks has been relatively neglected, and data are very limited in resource-limited countries. Broad health systems strengthening in the CLI is required. The present study reviews the key elements of the CLI associated with poor laboratory functioning, and proposes specific areas for improvement. The present study discuss case studies in South Africa and India, as well as reviewing data supporting interventions in public health clinics to improve the CLI.

SUMMARY

The CLI is a neglected area of the laboratory value chain. Reducing errors and increasing efficiencies will improve the laboratory service to patients.