Impact of a borderless sample transport network for scaling up viral load monitoring: results of a geospatial optimization model for Zambia

• Published in: Journal of the International AIDS Society Vol. 21; no. 12; pp. e25206 - n/a
• Main Authors: Nichols, Brooke E, Girdwood, Sarah J, Crompton, Thomas, Stewart‐Isherwood, Lynsey, Berrie, Leigh, Chimhamhiwa, Dorman, Moyo, Crispin, Kuehnle, John, Stevens, Wendy, Rosen, Sydney
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.12.2018; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Acquired immune deficiency syndrome; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Community Networks - economics; Cost control; cost modelling; Data collection; Dosage and administration; Drug resistance; Drug therapy; Geographic information systems; Geospatial data; geospatial modelling; Global positioning systems; GPS; health systems; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - economics; HIV Infections - virology; Human immunodeficiency virus; Humans; Models, Theoretical; Monitoring, Physiologic - economics; Monitoring, Physiologic - methods; Optimization; patient monitoring; Patients; Risk factors; Roads & highways; Testing laboratories; Transportation - economics; Transportation planning; Vehicles; viral load; Viral Load - economics; viral load scale‐up; World Health Organization; Zambia; Zambia; United States > US; Africa; cost modelling; geospatial modelling; health systems; viral load; patient monitoring; viral load scale-up
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25206

Introduction The World Health Organization recommends viral load (VL) monitoring at six and twelve months and then annually after initiating antiretroviral treatment for HIV. In many African countries, expansion of VL testing has been slow due to a lack of efficient blood sample transportation networks (STN). To assist Zambia in scaling up testing capacity, we modelled an optimal STN to minimize the cost of a national VL STN. Methods The model optimizes a STN in Zambia for the anticipated 1.5 million VL tests that will be needed in 2020, taking into account geography, district political boundaries, and road, laboratory and facility infrastructure. We evaluated all‐inclusive STN costs of two alternative scenarios: (1) optimized status quo: each district provides its own weekly or daily sample transport; and (2) optimized borderless STN: ignores district boundaries, provides weekly or daily sample transport, and reaches all Scenario 1 facilities. Results Under both scenarios, VL testing coverage would increase to from 10% in 2016 to 91% in 2020. The mean transport cost per VL in Scenario 2 was $2.11 per test (SD $0.28), 52% less than the mean cost/test in Scenario 1, $4.37 (SD $0.69), comprising 10% and 19% of the cost of a VL respectively. Conclusions An efficient STN that optimizes sample transport on the basis of geography and test volume, rather than political boundaries, can cut the cost of sample transport by more than half, providing a cost savings opportunity for countries that face significant resource constraints.