Improving Laboratory Efficiency in the Caribbean to Attain the World Health Organization HIV Treat All Recommendations
| Autor: | Giselle Guevara, George Alemnji, Songee Branch, John N. Nkengasong, Rachel Albalak, Martine Chase |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Quality management Referral United Nations Service delivery framework Anti-HIV Agents Cost-Benefit Analysis Point-of-Care Systems Immunology HIV Infections Efficiency Organizational World Health Organization Scientific evidence 03 medical and health sciences 0302 clinical medicine Procurement Virology Medicine Humans 030212 general & internal medicine Data collection business.industry Clinical Laboratory Techniques Viral Load 030112 virology CD4 Lymphocyte Count Infectious Diseases Early Diagnosis Risk analysis (engineering) Caribbean Region Evidence-Based Practice Health Services Research Public Health business Viral load HIV drug resistance |
| Zdroj: | AIDS research and human retroviruses. 34(2) |
| ISSN: | 1931-8405 |
| Popis: | Scientific evidence showing the benefits of early initiation of antiretroviral therapy (ART) prompted World Health organization (WHO) to recommend that all persons diagnosed as HIV positive should commence ART irrespective of CD4 count and disease progression. Based on this recommendation, countries should adopt and implement the HIV "Treat All" policy to achieve the UNAIDS 90-90-90 targets and ultimately reach epidemic control. Attaining this goal along the HIV treatment cascade depends on the laboratory to monitor progress and measure impact. The laboratory plays an important role in HIV diagnosis to attain the first 90 and in viral load (VL) and HIV drug resistance testing to reinforce adherence, improve viral suppression, and measure the third 90. Countries in the Caribbean region have endorsed the WHO HIV "Treat all" recommendation; however, they are faced with diminishing financial resources to support laboratory testing, seen as a rate-limiting factor to achieving this goal. To improve laboratory coverage with fewer resources in the Caribbean there is the need to optimize laboratory operations to ensure the implementation of high quality, less expensive evidence-based approaches that will result in more efficient and effective service delivery. Suggested practical and innovative approaches to achieve this include: (1) targeted testing within HIV hotspots; (2) strengthening sample referral systems for VL; (3) better laboratory data collection systems; and (4) use of treatment cascade data for programmatic decision-making. Furthermore, strengthening quality improvement and procurement systems will minimize diagnostic errors and guarantee a continuum of uninterrupted testing which is critical for routine monitoring of patients to meet the stated goal. |
| Databáze: | OpenAIRE |
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