Girdwood Sarah J, Crompton Thomas, Cassim Naseem, Olsen Floyd, Sejake Portia, Diallo Karidia, Berrie Leigh, Chimhamhiwa Dorman, Stevens Wendy, Nichols Brooke
Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Afr J Lab Med. 2022 Oct 25;11(1):1725. doi: 10.4102/ajlm.v11i1.1725. eCollection 2022.
South Africa uses a courier network for transporting specimens to public laboratories. After the daily collection of specimens from the facility by the courier, patients not yet attended to are unlikely to receive same-day blood draws, potentially inhibiting access to viral load (VL) testing for HIV patients.
We aimed to design an optimised courier network and assess whether this improves VL testing access.
We optimised the specimen transport network in South Africa for 4046 facilities (November 2019). For facilities with current specimen transport times ( = 356), we assessed the relationship between specimen transport time and VL testing access (number of annual VL tests per antiretroviral treatment patient) using regression analysis. We compared our optimised transport times with courier collection times to determine the change in access to same-day blood draws.
The number of annual VL tests per antiretroviral treatment patient (1.14, standard deviation: 0.02) was higher at facilities that had courier collection after 13:36 (the average latest collection time) than those that had their last collection before 13:36 (1.06, standard deviation: 0.03), even when adjusted for facility size. Through network optimisation, the average time for specimen transport was delayed to 14:35, resulting in a 6% - 13% increase in patient access to blood draws.
Viral load testing access depends on the time of courier collection at healthcare facilities. Simple solutions are frequently overlooked in the quest to improve healthcare. We demonstrate how simply changing specimen transportation timing could markedly improve access to VL testing.
南非利用快递网络将样本运送到公共实验室。快递员每天从医疗机构收集样本后，尚未就诊的患者不太可能在当天进行血液检测，这可能会限制艾滋病毒患者进行病毒载量（VL）检测。
我们旨在设计一个优化的快递网络，并评估这是否能改善病毒载量检测的可及性。
我们对南非4046家医疗机构的样本运输网络进行了优化（2019年11月）。对于当前有样本运输时间的医疗机构（n = 356），我们使用回归分析评估样本运输时间与病毒载量检测可及性（每位抗逆转录病毒治疗患者每年的病毒载量检测次数）之间的关系。我们将优化后的运输时间与快递收集时间进行比较，以确定当天血液检测可及性的变化。
即使在根据医疗机构规模进行调整后，在13:36（平均最晚收集时间）之后进行快递收集的医疗机构中，每位抗逆转录病毒治疗患者每年的病毒载量检测次数（1.14，标准差：0.02）高于在13:36之前进行最后一次收集的医疗机构（1.06，标准差：0.03）。通过网络优化，样本运输的平均时间推迟到了14:35，患者进行血液检测的可及性提高了6% - 13%。
病毒载量检测的可及性取决于医疗机构快递收集的时间。在寻求改善医疗保健的过程中，简单的解决方案常常被忽视。我们证明了仅仅改变样本运输时间就能显著提高病毒载量检测的可及性。
