Coetzee Lindi-Marie, Cassim Naseem, Glencross Deborah K
National Priority Programme, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa.
Afr J Lab Med. 2022 Jun 3;11(1):1376. doi: 10.4102/ajlm.v11i1.1376. eCollection 2022.
The Northern Cape is South Africa's largest province with an HIV prevalence of 7.1% versus a 13.5% national prevalence. CD4 testing is provided at three of five National Health Laboratory Service district laboratories, each covering a 250 km precinct radius. Districts without a local service report prolonged CD4 turn-around times (TAT).
This study documented the impact of a new CD4 laboratory in Tshwaragano in the remote John Taolo Gaetsewe district of the Northern Cape, South Africa.
CD4 test volumes and TAT (total, pre-analytical, analytical, and post-analytical) data for the Northern Cape province were extracted for June 2018 to October 2019. The percentage of CD4 results within the stipulated 40-h TAT cut-off and the median and 75th percentiles of all TAT parameters were calculated. Pre-implementation, samples collected at Tshwaragano were referred to Kimberley or Upington, Northern Cape, South Africa.
Pre-implementation, 95.4% of samples at Tshwaragano were referred to Kimberley for CD4 testing (36.3% of Kimberley's test volumes). Only 7.5% of Tshwaragano's total samples were referred post-implementation. The Tshwaragano laboratory's CD4 median total TAT decreased from 24.7 h pre-implementation to 12 h post-implementation ( = 0.003), with > 95.0% of results reported within 40 h. The Kimberley laboratory workload decreased by 29.0%, and testing time significantly decreased from 10 h to 4.3 h.
The new Tshwaragano CD4 service significantly decreased local TAT. Upgrading existing community laboratories to include CD4 testing can alleviate provincial service load and improve local access, TAT and efficiency in the centralised reference laboratory.
北开普省是南非最大的省份，其艾滋病毒流行率为7.1%，而全国流行率为13.5%。五个国家卫生实验室服务地区实验室中有三个提供CD4检测，每个实验室覆盖半径250公里的区域。没有本地服务的地区报告称CD4检测周转时间（TAT）延长。
本研究记录了南非北开普省偏远的约翰·陶洛·盖特塞韦区茨瓦拉加诺新建的CD4实验室的影响。
提取了2018年6月至2019年10月北开普省的CD4检测量和TAT（总时间、分析前时间、分析时间和分析后时间）数据。计算了在规定的40小时TAT截止时间内CD4检测结果的百分比以及所有TAT参数的中位数和第75百分位数。在实施前，茨瓦拉加诺采集的样本被送往南非北开普省的金伯利或乌平顿进行CD4检测。
实施前，茨瓦拉加诺95.4%的样本被送往金伯利进行CD4检测（占金伯利检测量的36.3%）。实施后，茨瓦拉加诺的样本中只有7.5%被送检。茨瓦拉加诺实验室的CD4总TAT中位数从实施前的24.7小时降至实施后的12小时（P = 0.003），超过95.0%的结果在40小时内报告。金伯利实验室的工作量减少了29.0%，检测时间从10小时显著缩短至4.3小时。
新建的茨瓦拉加诺CD4服务显著缩短了当地的TAT。升级现有社区实验室以包括CD4检测可以减轻省级服务负担，并改善当地的检测机会、TAT以及集中参考实验室的效率。
