An Integrated Tiered Service Delivery Model (ITSDM) Based on Local CD4 Testing Demands Can Improve Turn-Around Times and Save Costs whilst Ensuring Accessible and Scalable CD4 Services across a National Programme

• DOI: 10.1371/journal.pone.0114727
• Publication Date: 2014-12-09T19:04:34Z
• Authors: Deborah K. Glencross; Lindi M. Coetzee; Naseem Cassim
• Keywords: Tier 2 network; Tier 1 network; Point-of-Care Testing

The South African National Health Laboratory Service (NHLS) responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART), has demanded extending meet increasing clinical needs. aim of this study was review existing and develop a service-model that integrated laboratory-based point-of-care testing (POCT), extend national coverage, improve local turn-around/(TAT) contain costs.NHLS Corporate Data Warehouse data, from 60-70 laboratories 4756 referring health facilities reviewed for referral workload, respective facility volumes related TAT, 2009-2012.An tiered service delivery model (ITSDM) is proposed. Tier-1/POCT delivers at single health-clinics providing ART hard-to-reach areas (<5 samples/day). Laboratory-based extended Tier-2/POC-Hubs (processing ≤ 30-40 samples/day), consolidating POCT across 8-10 other HIV-related Tier-3/'community' laboratories, serving 40 health-clinics, processing 150 samples/day. Existing Tier-4/'regional' serve 100 process <350 samples/day; Tier-5 are high-volume 'metro'/centralized (>350-1500 tests/day, ≥ 200 health-clinics). Tier-6 provides support standardisation, harmonization quality the organization.The ITSDM offers improved TAT by into rural/remote new Tier-3 or Tier-2/POC-Hub installed community most developed infrastructure. advantage lower costs use infrastructure enables subsidization expensive POC services, districts without reasonable laboratory. Full implementation 5 tiers (as opposed widespread service) can facilitate sustainable 'full coverage' Africa, save>than R125 million HIV/AIDS costs. hierarchical parental-support also assures laboratory/POC management, equipment maintenance, control on-going training between tiers.