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Table 1 Summary of Public-Private Partnerships (PPPs) (2007–2017) that address barriers and strengthen laboratory systems in resource-limited settings to improve access, coverage, quality and utilization of Viral Load and Early Infant Diagnosis testing

From: Role of public-private partnerships in achieving UNAIDS HIV treatment targets

Cascade phase Barrier Country PPP PPP Intervention Impact Source
Pre-analytical Phase Poor and non-standardized specimen collection procedures. Kenya L4L • Trained 91 HCW on safe phlebotomy collection practices. • Increased knowledge of phlebotomists by 41%. • Integration of safe phlebotomy practices into pre-service training. Kimani, [26]
Weak supply chain and unreliable specimen transportation system. Gambia, Kenya, Lesotho, Malawi, Nigeria, Zambia, Zimbabwe. Riders for Health • Accessed hard-to- reach communities for healthcare needs by providing motorcycles for transportation. • Trained healthcare workers on managing supply chain distribution of medicines, transportation of specimens and return of results and managed emergency referrals. • Improved access to 14.5 million people to healthcare. • Transported 400, 000 specimens/year between laboratory and healthcare facilities. WHO [23, 28] World Bank [15]
Weak specimen transportation system. Uganda L4L • Use of GIS to map efficient sample referral network. • Provided standardized specimen transportation materials. • Training of transporters to safely package and transport specimens. • Ten-fold increase in referrals of patients sample with presumptive MDR-TB. • 94% specimens reached the national laboratory within the established target time of 72 h. Joloba et al., [27]
Analytical Phase Lack of skilled workforce, modern laboratory infrastructure to provide timely and accurate services to patients. SSA Global Access Program • Engaged manufacturer and negotiated lower prices for HIV VL and EID reagents. • 300, 000 infants enrolled into care and treatment. • Provided 900,000 tests for EID. • – Projected anticipated cost savings of $150 million in next 5 years. Roche Diagnostics [20]
SSA Turn Key Laboratory • Set up‘Turn Key Laboratory’ for access to pediatric testing. • 900,000 tests were made available. • 100 laboratories in SSA now routinely offer PCR for EID. Roche Diagnostics [20]
Mozambique L4L • Establishment of national laboratory quality assurance program to facilitate stepwise quality improvement of laboratory services. • Trained and mentorship resulted in 18 MOH qualified auditors and 28 manager/quality officers capacitated to manage improvements of laboratories and steer towards accreditation. Skaggs et al., [29]
Tanzania Abbott Fund • Built and modernized 23 regional-level laboratories, • Built outpatient center at the national hospital serving 1000 patients/day. • Provided mentorship. • 10 fold increase (from 110,000 to 1,158,000) in test volumes in 5 years. • Improved healthcare services for people living with HIV and other chronic diseases across the country. Abbott Fund [25]
Post - analytical phase Delayed and inconsistent delivery of VL and EID test results to patients. Ethiopia L4L • Used GIS to map and network 554 clinic facilities to laboratories testing for VL, EID, CD4 and hematology. • Procured 400 standard specimen transportation containers. • Trained 586 and 81 laboratory and postal workers, respectively. • 50% reduction in TAT (from specimen collection to reporting results) for ART patients (10 to 5 days). • Standardized training module used for training in all the regions • 62% in cost savings for transporting EID specimens. • Reduced TAT from 1 to 2 months to 5–10 days. Kebede et al., [32] Kiyaga et al. [6]
Kenya, Tanzania and Rwanda Phones for Health • Allowed input of health data and transfer to central database. • Enabled ordering medicines, sending alerts and download of guidelines. • Enabled access to training materials. • Facilitated transmission of results to SMS printers. • Improved access to knowledge and information of 50,000 community health workers. • Reduced TAT for results delivery • Effective monitoring of mother-to-child transmission through EID systems rolled out to 63 sites nationally. UNAIDS [25], Fogarty [24]
  1. a = Labs for Life;
  2. Abbreviations: L4L Labs for Life, HCW healthcare workers, GIS geographic information system, MDR-TB multidrug resistant tuberculosis, PCR polymerase chain reaction, SSA sub Saharan Africa, VL viral load, EID early infant diagnosis, ART antiretroviral therapy, MOH ministry of health, TAT turnaround time, WHO World Health Organization, CD4 cluster of differentiation 4, SMS short message service