Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117457

Sarah Gimbel-Sherr, RN, MA¹, Elizabeth Coehlo, MD², Kenneth Gimbel-Sherr, MPH¹, Mark A. Micek, MD, MPH³, Ana Judite Blanco⁴, Rosa Marlene Manjate, MD, MPH², and Stephen Gloyd, MD, MPH⁵. (1) Epidemiology, University of Washington, 178 27th Avenue, Seattle, WA 98122, 206 427 6889, sgimbel@u.washington.edu, (2) Department of Clinical Medicine, Ministry of Health, Rua Eduardo Mondlane, Maputo, Mozambique, (3) International Health Program, Department of Health Services, University of Washington, Box 354809, University of Washington, Seattle, WA 98195, (4) Health Alliance International, PO Box 1227, Mutare, Zimbabwe, (5) Health Services/International Health, University of Washington, 1959 NE Pacific Street, H-660 P.O. Box 357660, Seattle, WA 98195-7660

Issues: Currently there is substantial support to scale-up antiretroviral therapy (ART) in resource-poor settings. In June 2003, Mozambique initiated a 5-year HIV/AIDS care and treatment plan to provide public sector care and ART for >400,000 patients nationwide. Improving laboratory capacity, including CD4 testing, is a cornerstone of the national plan, and provides basic information used to guide treatment decisions. Challenges to building a national CD4 network include a weak laboratory system, logistical difficulties, lack of human resources, and donor coordination. Description: Mozambique adopted a centralized CD4 approach, using high-throughput technology, to overcome these obstacles. Analyzing Mozambique's experience with designing and implementing improved laboratory services highlights obstacles and potential solutions. An overview of the development process will be provided, including results to date, the role of stakeholders, as well as costs, benefits and limitations of a centralized testing approach. Lessons Learned: Two CD4 laboratories were initially chosen based on human resource capacity, patient load, technical assistance, and geographic location. DHL was contracted to transport samples and results. Centralized planning permitted cost-effective bulk orders ($3.54/test). Within 6 months 11,000 samples were processed, which increased to 35,000 by 12 months (average processing time=7 days). Presently 3 CD4 labs process ~4000 tests monthly. Recommendations: The centralized approach to CD4 testing facilitates communication and transport between laboratories and HIV clinics, and reduces challenges related to human resources, maintenance, and quality assurance. Donor pressure to expand more, smaller CD4 machines (costs ~$10.00/test) may be misguided due to human resource, logistic, quality assurance and maintenance considerations.

Learning Objectives: "At the conclusion of the session, the participants in this section will be able to

• Recognize the opportunities inherent in the development of a laboratory transport plan.
• Define the challenges inherent in developing a national laboratory transport plan.
• Identify key factors to consider when carrying out a rapid laboratory assessment.

Keywords: Antiretroviral Combination Therapy, International Public Health

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.