Consolidating HIV testing in a public health laboratory for efficient and sustainable early infant diagnosis (EID) in Uganda

• Published in: Journal of public health policy 2015-05, Vol.36 (2), p.153-169
• Main Authors: Kiyaga, Charles, Sendagire, Hakim, Joseph, Eleanor, Grosz, Jeff, McConnell, Ian, Narayan, Vijay, Esiru, Godfrey, Elyanu, Peter, Akol, Zainab, Kirungi, Wilford, Musinguzi, Joshua, Opio, Alex
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Babies; Blood; Early Diagnosis; Epidemiology; Equality and Human Rights; Health facilities; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - transmission; Hospitals; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Infants; Infectious Disease Transmission, Vertical; Laboratories - economics; Laboratories - organization & administration; Medical laboratories; Medical Sociology; Medical tests; Mortality; Mothers; Original Article; Pediatrics; Polymerase Chain Reaction; Public Health; Public Health Administration; Retrospective Studies; Social Justice; Social Policy; Social Sciences; Sociology; Uganda; Urban areas
• ISSN: 0197-5897; 1745-655X
• DOI: 10.1057/jphp.2015.7

Uganda introduced an HIV Early Infant Diagnosis (EID) program in 2006, and then worked to improve the laboratory, transportation, and clinical elements. Reported here are the activities involved in setting up a prospective analysis in which the Ministry of Health, with its NGO partners, determined it would be more effective and efficient to consolidate the initial eight-laboratory system for EID testing of HIV dried blood samples offered by two nongovernmental partners operating research facilities into a single well-equipped and staffed laboratory within the Ministry. A retrospective analysis confirmed that redesign reduced overhead cost per PCR test of HIV dried blood samples from US$22.20 to an averarage of $5. Along with the revamped system of sample collection, transportation, and result communication, Uganda has been able to vastly increase the HIV diagnosis of babies and engagement of them and their mothers in clinical care, including antiretroviral therapy. Uganda reduced turnaround times for results reporting to clinicians from more than a month in 2006 to just 2 weeks by 2014, even as samples tested increased dramatically. The next challenge is overcoming loss of babies and mothers to follow up.