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 et.al., [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. | 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. |