220963 Addressing laboratory sample transportation challenges in Swaziland: Making use of inexpensive public transport as a reliable alternative

Monday, November 8, 2010

Peter Preko, MD, MPH , ICAP-Swaziland, Columbia University, Eveni, Swaziland
Kerry Bruce, MPH, MA , ICAP-Swaziland, Columbia University, Eveni, Swaziland
Londiwe Nkambule , ICAP-Swaziland, Columbia University, Eveni, Swaziland
Harrison Kamiru, BDS, MSc, DrPH , ICAP-Swaziland, Columbia University, Eveni, Swaziland
Joris Vandelanotte, MD, MPH , ICAP-Swaziland, Columbia University, Eveni, Swaziland
Hosea Sukati , National Reference Laboratory, Ministry Of Health, Mbabane, Swaziland
Velephi Okello, MD , Swaziland National AIDS Program, Ministry Of Health, Mbabane, Swaziland
ISSUES: Since 2006, the International Center for AIDS Care and Treatment Programs (ICAP), supported by US government, has assisted the Ministry of Health (MOH) in developing HIV/AIDS programs in Swaziland. Laboratory samples transportation is the main challenge to efforts at providing quality decentralized HIV/AIDS services resulting in poor client monitoring, delays in initiating patients on ART, poor specimen tracking, long turn-around times and loss-to-follow-up. Poor funding has crippled a national lab transportation system. DESCRIPTION ICAP and MOH piloted a daily lab sample transport system in six facilities using local public mini-buses (kombis) over a six-week period. The objective was to identify a reliable and inexpensive stop-gap alternative until the national lab transportation system is fixed. Samples were documented, triple-bagged and transported daily to the lab by a phlebotomist or orderly riding in the kombis. The staff then brought back available test results. LESSONS LEARNED Transporting lab samples via public transport is feasible. It is inexpensive ($4.09/site/day), convenient and more reliable. It resulted in zero loss-to-follow-up during the period, a 13-fold increase in the monthly average number of clients who had blood drawn, a significant reduction in sample turn-around time from 13 to 3 days leading to more rapid preparation of clients for ART initiation. The system also made feasible on-site sputum collection which helped fast-track TB diagnosis and treatment. RECOMMENDATIONS Implement the kombi lab-transport-system in the short term until a better national system can be created and operationalized. Share lessons learned and work on identified gaps with stakeholders.

Learning Areas:
Program planning
Provision of health care to the public

Learning Objectives:
1. To demonstrate how useful local public transport could be as an alternative to standard sample transportation in resource-constraint settings. 2. To evaluate how using public transport for transporting lab samples impacted on patient care at pilot sites.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Country Director for the program that implemented this program and was involved the development of the pilot.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.