Impact of Specimen Referral Network to Rapidly Scale-Up CD4 Testing in Nigeria

ABSTRACT Background. Regular, efficient and quality CD4 testing is vital to track disease progression in people living with human immunodeficiency virus (HIV). The lack of sample referral networks resulted in unacceptably long turnaround times (TAT) for laboratory results. The major objective of this study is to assess the contribution of integrated specimen referral network to rapidly scale up CD4 testing to accelerate progress towards the UNAIDS 90–90–90 treatment target for HIV. Methods. This is a retrospective study conducted on the reported activities of all 3PL service providers from March 2018 to March 2019. Information was obtained from all the approved CD4 diagnostic centres across all the 36 states and the Federal Capital Territory (FCT) of Nigeria. Tracking records and reports of all centres were also obtained. The total number of specimens rejected was obtained from each centre from the data extraction tool set up by Axios Foundation. Data from bi-monthly quality indicator reports, which included specimen rejection and workload statistics, were included. The data obtained were inputted and analyzed with IBM-SPSS version 25.0. Results. The total number of samples transported in the 13 months was 17,629 with the highest number of samples (17.4%) transported in Cross River state. Exactly 15.0% of these samples were transported in Rivers state and FCT had the third-largest sample movement of 12.9%. Cross River, Rivers, and FCT also recorded the highest number of reported results of 87%, 68%, and 64% respectively. There was a steady increase in the number of samples and results transported until July 2018 where the highest peak (2,085) was recorded. Two other peaks were observed in November 2018 (1,979) and February 2019 (1,889). There were 54 (0.31%) rejected samples recorded in the entire 13 months. Although the highest number of transported samples were recorded in Cross River and Rivers states, no sample rejection was recorded in these states. Conclusion. The integrated specimen referral network has significantly scaled-up specimen referral and results-reporting networks by increasing access to CD4 count testing that has significantly contributed to ART-related monitoring. This integrated service is very important for enhancing the specimen referral system and increasing access to quality laboratory services in Nigeria. The successful implementation of the integrated system may be relevant to other areas of laboratory services other than sample referrals. RESUME Contexte. Un depistage regulier, efficace et de qualite du CD4 est essentiel pour suivre la progression de la maladie chez les personnes vivant avec le virus de l’immunodeficience humaine (VIH). L’absence de reseaux d’aiguillage d’echantillons a entraine des delais d’execution inacceptablement longs (TAT) pour les resultats de laboratoire. L’objectif principal de cette etude est d’evaluer la contribution du reseau integre d’aiguillage des echantillons pour accroitre rapidement le depistage du CD4 afin d’accelerer les progres vers l’objectif de traitement du VIH 90-90 pour l’ONUSIDA. Methodes. Il s’agit d’une etude retrospective menee sur les activites declarees de l’ensemble des prestataires de services 3PL de mars 2018 a mars 2019. Des informations ont ete obtenues aupres de tous les centres de diagnostic CD4 approuves dans les 36 Etats et du Territoire de la capitale federale (FCT) du Nigeria. Des dossiers de suivi et des rapports de tous les centres ont egalement ete obtenus. Le nombre total de specimens rejetes a ete obtenu a partir de chaque centre a partir de l’outil d’extraction de donnees mis en place par la Fondation Axios, donnees tirees des rapports semestriels sur les indicateurs de qualite. Resultats. Le nombre total d’echantillons transportes au cours des 13 mois etait de 17 629, le plus grand nombre d’echantillons (17,4 %) transportes dans l’Etat de Cross River. Exactement 15,0 % de ces echantillons ont ete transportes dans l’Etat de Rivers et FCT a eu le troisieme mouvement d’echantillon en importance de 12,9 %. Cross River, Rivers et FCT ont egalement enregistre le plus grand nombre de resultats declares, soit 87 %, 68 % et 64 % respectivement. Le nombre d’echantillons et de resultats transportes a augmente regulierement jusqu’en juillet 2018, ou le pic le plus eleve (2 085) a ete enregistre. Deux autres pics ont ete observes en novembre 2018 (1 979) et en fevrier 2019 (1 889). Il y en avait 54 (0,31 %) echantillons rejetes enregistres au cours des 13 mois. Bien que le plus grand nombre d’echantillons transportes ait ete enregistre dans les Etats de Cross River et de Rivers, aucun rejet d’echantillon n’a ete enregistre dans ces Etats. Conclusion. Le reseau integre d’aiguillage des echantillons a considerablement elargi les reseaux d’aiguillage et de rapport des resultats en augmentant l’acces aux tests de comptage des CD4 qui ont contribue de facon significative a la surveillance liee au TAR. Ce service integre est tres important pour ameliorer le systeme de reference des specimens et accroitre l’acces aux services de laboratoire de qualite au Nigeria. La mise en œuvre reussie du systeme integre peut etre pertinente pour d’autres secteurs de services de laboratoire autres que les references d’echantillons