Long Turnaround Times in Viral Load Monitoring of People Living with HIV in Resource-Limited Settings

Fredrick Mbiva; Hannock Tweya; Srinath Satyanarayana; Kudakwashe Takarinda; Collins Timire; Janet Dzangare; Phoebe Nzombe; Tsitsi M Apollo; Bekezela Khabo; Exevia Mazarura

doi:10.4103/jgid.jgid_172_19

Long Turnaround Times in Viral Load Monitoring of People Living with HIV in Resource-Limited Settings

J Glob Infect Dis. 2021 Mar 22;13(2):85-90. doi: 10.4103/jgid.jgid_172_19. eCollection 2021 Apr-Jun.

Authors

Fredrick Mbiva¹, Hannock Tweya^{2

3}, Srinath Satyanarayana², Kudakwashe Takarinda^{1

2}, Collins Timire^{1

2}, Janet Dzangare¹, Phoebe Nzombe⁴, Tsitsi M Apollo¹, Bekezela Khabo¹, Exevia Mazarura⁵

Affiliations

¹ Ministry of Health and Child Care, AIDS and Tuberculosis Program, Paris, France.
² The International Union Against Tuberculosis and Lung Disease, Center for Operational Research, Paris, France.
³ The Lighthouse Trust Monitoring, Evaluation and Research Department, Lilongwe, Malawi.
⁴ The International Union Against Tuberculosis and Lung Disease, Harare, Zimbabwe.
⁵ Ministry of Health and Child Care, National Microbiology Reference Laboratory, Harare, Zimbabwe.

Abstract

Introduction: Routine viral load (VL) testing is fraught with challenges in resource-limited settings which lead to longer turnaround times for the return of VL results. We assessed the turnaround times for VL testing and factors associated with long turnaround (>30 days) in Marondera, Zimbabwe, between January and September 2018.

Methods: This was an analytical study of routine program data. Data were extracted from electronic records and paper-based reports at two laboratories and at antiretroviral therapy (ART) facilities. The unit of analysis was the VL sample. Duration (in days) between sample collection and sample testing (pre-test turnaround time), duration between sample testing and receipt of VL result at ART the site (post-test turnaround time), and duration between sample collection and receipt of result at the ART site (overall turnaround time) were calculated. Days on which the VL testing machine was not functional, and workload (number of tests done per month) were used to assess associations. We used binomial log models to assess the factors associated with longer turnaround time.

Results: A total of 3348 samples were received at the two VL testing laboratories, and 3313 were tested, of these, 1111 were analyzed for overall turnaround time. Pre-test, post-test, and overall turnaround times were 22 days (interquartile range (IQR): 11-41), 51 days (IQR: 30-89), and 67 days (IQR: 46-100), respectively. Laboratory workload (relative risk [RR]: 1.12, 95% confidence interval [CI]: 1.10-1.14) and machine break down (RR: 1.15, 95% CI: 1.14-1.17) were associated with long turnaround time.

Conclusions: Routine VL turnaround time was long. Decentralizing VL testing and enhancing laboratory capacity may help shorten the turnaround time.

Keywords: Decentralization; Structured Operational Research and Training Initiative; operational research; turnaround time; viral load.