Cost and Impact of Dried Blood Spot Versus Plasma Separation Card for Scale-up of Viral Load Testing in Resource-limited Settings

Abstract Background Routine plasma viral load (VL) testing is recommended for monitoring human immunodeficiency virus–infected patients on antiretroviral therapy. In Zambia, VL scale-up is limited due to logistical obstacles around plasma specimen collection, storage, and transport to centralized laboratories. Dried blood spots (DBSs) could circumvent many logistical challenges at the cost of increased misclassification. Recently, plasma separation cards (PSCs) have become available and, though more expensive, have lower total misclassification than DBSs. Methods Using a geospatial model created for optimizing VL utilization in Zambia, we estimated the short-term cost of uptake/correct VL result using either DBSs or PSCs to increase VL access on equipment available in-country. Five scenarios were modeled: (1) plasma only (status quo); (2) plasma at high-volume sites, DBS at low-volume sites; (3) plasma at high-volume sites, PSC at low-volume sites; (4) PSC only; (5) DBS only. Results Scenario 1 resulted in 795 342 correct results due to limited patient access. When allowing for full and partial adoption of dried specimens, access increases by 19%, with scenario 3 producing the greatest number of correct results expected (929 857). The average cost per correct VL result was lowest in the plasma + DBS scenario at $30.90 compared to $31.62 in our plasma + PSC scenario. The cost per correct result of using dried specimens only was dominated in the incremental analysis, due primarily to fewer correct results. Conclusions Adopting the partial use of dried specimens will help achieve improved VL access for patients at the lowest cost per correct result.

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Pooled HIV-1 Viral Load Testing Using Dried Blood Spots to Reduce the Cost of Monitoring Antiretroviral Treatment in a Resource-Limited Setting

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182a61e63 ◽

2013 ◽

Vol 64 (2) ◽

pp. 134-137 ◽

Cited By ~ 21

Author(s):

Pieter Pannus ◽

Emmanuel Fajardo ◽

Carol Metcalf ◽

Rebecca M. Coulborn ◽

Laura T. Durán ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Treatment ◽

Dried Blood Spots ◽

Resource Limited Setting ◽

Load Testing ◽

Blood Spots ◽

Resource Limited ◽

The Cost ◽

Hiv 1 ◽

Limited Setting

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Accurate dried blood spots collection in the community using non-medically trained personnel could support scaling up routine viral load testing in resource limited settings

PLoS ONE ◽

10.1371/journal.pone.0223573 ◽

2019 ◽

Vol 14 (10) ◽

pp. e0223573 ◽

Cited By ~ 2

Author(s):

Kombatende Sikombe ◽

Cardinal Hantuba ◽

Kalo Musukuma ◽

Anjali Sharma ◽

Nancy Padian ◽

...

Keyword(s):

Viral Load ◽

Scaling Up ◽

Dried Blood Spots ◽

Load Testing ◽

Resource Limited Settings ◽

Blood Spots ◽

Viral Load Testing ◽

Resource Limited ◽

Trained Personnel

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Reflex viral load testing in dried blood spots generated by plasma separation card allows the screening and diagnosis of chronic viral hepatitis

Journal of Virological Methods ◽

10.1016/j.jviromet.2020.114039 ◽

2021 ◽

Vol 289 ◽

pp. 114039

Author(s):

Joan Martínez-Campreciós ◽

Ariadna Rando-Segura ◽

María Buti ◽

Fernando Rodrigo-Velásquez ◽

Mar Riveiro-Barciela ◽

...

Keyword(s):

Viral Load ◽

Viral Hepatitis ◽

Dried Blood Spots ◽

Chronic Viral Hepatitis ◽

Load Testing ◽

Plasma Separation ◽

Blood Spots ◽

Viral Load Testing ◽

Screening And Diagnosis

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Viral load testing in a resource-limited setting: quality control is critical

Journal of the International AIDS Society ◽

10.1186/1758-2652-14-23 ◽

2011 ◽

Vol 14 (1) ◽

pp. 23-23 ◽

Cited By ~ 7

Author(s):

Jane Greig ◽

Philipp du Cros ◽

Derryck Klarkowski ◽

Clair Mills ◽

Steffen Jørgensen ◽

...

Keyword(s):

Quality Control ◽

Viral Load ◽

Resource Limited Setting ◽

Load Testing ◽

Viral Load Testing ◽

Resource Limited ◽

Limited Setting

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The Cost of Implementation of the Clinical Laboratory Improvement Amendments of 1988—The Example of Pediatric Office-Based Cholesterol Screening

PEDIATRICS ◽

10.1542/peds.96.2.230 ◽

1995 ◽

Vol 96 (2) ◽

pp. 230-234

Author(s):

Andrew M. Tershakovec ◽

S. Diane Brannon ◽

Michael J. Bennett ◽

Barbara M. Shannon

Keyword(s):

Proficiency Testing ◽

Laboratory Testing ◽

Clinical Laboratory ◽

High Volume ◽

Chemistry Laboratory ◽

Screening Process ◽

Cholesterol Screening ◽

Low Volume ◽

The Cost ◽

Clinical Laboratory Improvement Amendments

Objective. To measure the additional costs of office-based laboratory testing due to the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), using cholesterol screening for children as an example. Methods. Four-to ten-year-old children who received their well child care at one of seven participating pediatric practices were screened for hypercholesterolemia. The average number of analyses per day and days per month were derived from the volume of testing completed by the practices. Nurses and technicians time in the screening process were measured and personnel costs were calculated based on salary and fringe benefit rates. Costs of supplies, analyzing control samples, instrument calibration, and instrument depreciation were included. Costs estimates of screening were then completed. CLIA '88 implementation costs were derived from appropriate proficiency testing and laboratory inspection programs. Results. In six practices completing a low volume of testing, 2807 children (5 to 6 children per week) were screened during the observation period, while 414 (about 25 children per week) were screened in one high-volume practice implementing universal screening over a 4-month period. For the six low-volume practices, the cost of screening was $10.60 per child. This decreased to $5.47 for the high-volume practice. Estimated costs of CLIA '88 implementation, including additional proficiency testing and laboratory inspection, added $3.20 per test for the low-volume practices, and $0.71 per test for the high-volume testing. Conclusions. Implementation of CLIA adds significantly to the cost of office-based chemistry laboratory screening. Despite these additional expenses, the cost of testing is still within a reasonable charge for laboratory testing, and is highly sensitive to the volume of tests completed.

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Cost per insertion and couple year of protection for postpartum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda

Gates Open Research ◽

10.12688/gatesopenres.12858.2 ◽

2019 ◽

Vol 2 ◽

pp. 39

Author(s):

Kristin M. Wall ◽

Rosine Ingabire ◽

Susan Allen ◽

Etienne Karita

Keyword(s):

Intrauterine Device ◽

Scale Up ◽

High Volume ◽

Health Facilities ◽

System Perspective ◽

Doctoral Level ◽

Government Hospitals ◽

Implementation Costs ◽

The Government ◽

The Cost

Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented postpartum intrauterine device (PPIUD) and postpartum (PP) implant promotional counseling and service delivery procedures between May-July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. The goal of the present analysis is to detail implementation expenditures and estimate incremental costs per insertion and couple years of protection (CYP) for PPIUD and PP implant users. Methods: We detail the incremental costs during the implementation from the health system perspective (including both the implementation costs and the cost of contraceptive methods) and use of standard methods to estimate the cost per insertion and CYP for PPIUD and PP implant users. In addition to the incremental costs of labor and supplies, the costs of promotional activities are included. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $5/PPIUDs and $20/PP implant. Conclusion: Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.

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Virological Outcomes and Risk Factors for Non-suppression for Routine and Repeat Viral Load Testing After Enhanced Adherence Counselling During Viral Load Testing Scale-up in Zimbabwe: Analytic Cross-sectional Study Using Laboratory Data From 2014 to 2018.

10.21203/rs.3.rs-1220438/v1 ◽

2022 ◽

Author(s):

Trudy Tholakele Mhlanga ◽

Bart K.M Jacobs ◽

Tom Decroo ◽

Emma Govere ◽

Hilda Bara ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Viral Load ◽

Scale Up ◽

Cross Sectional Study ◽

Load Testing ◽

Sectional Study ◽

Cross Sectional ◽

Viral Load Testing ◽

Adherence Counselling

Abstract BackgroundSince the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling" VL results.MethodsWe conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received enhanced adherence counselling. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL.ResultsWe analysed 103 609 VL test results (101 725 routine and 1884 repeat tests results) collected from the country's ten provinces. Of the 101 725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR)=1.19, [95% CI:1.14-1.24]) and adolescents (vs adults, aOR=3.11, [95%CI:2.9-3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR=1.21, [95%CI:1.17-1.26]) and tertiary level (vs primary, aOR=1.63, [95%CI:1.44-1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014-2015 (vs <2010, aOR=0.83, [95%CI:0.79-0.88]) and from 2016 onwards (vs <2010, aOR=0.84, [95%CI:0.79-0.89]) had a lower risk of VL non-suppression. For repeat VL tests; young adults (vs adults, (aOR)=3.48, [95% CI 2.16 -5.83]), adolescents (vs adults, aOR=2.76, [95% CI:2.11-3.72]) and children (vs adults, aOR=1.51, [95%CI:1.03-2.22]) were at risk of VL non-suppression.ConclusionClose to 90% suppression in routine VL shows that Zimbabwe is on track to reach the third UNAIDS target. Strategies to improve the identification of clients with high routine VL results for repeating testing after EAC and ART adherence in subpopulations (men, adolescents and young adolescents) at risk of viral non-suppression should be prioritised.

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