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Improving HIV Early Infant Diagnosis Supply Chains in Sub-Saharan Africa: Models and Application to Mozambique

Author

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  • Jónas Oddur Jónasson

    (MIT Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142)

  • Sarang Deo

    (Indian School of Business, Gachibowli, Hyderabad, India, 50032)

  • Jérémie Gallien

    (London Business School, Regent’s Park, London NW1 4SA, United Kingdom)

Abstract

Early diagnosis of the human immunodeficiency virus (HIV) among infants born to HIV-infected mothers is critical because roughly 50% of untreated infected infants die before the age of two years. Yet most countries in sub-Saharan Africa experience significant delays in diagnosis because of operational inefficiencies in early infant diagnosis (EID) networks. We develop a two-part modeling framework relying on optimization and simulation to generate operational improvements in the assignment of clinics to laboratories and the allocation of capacity across laboratories, and to evaluate the associated impact on the number of infants initiating treatment. Applying our methodology to EID program data from Mozambique, we validate our simulation model and estimate that optimally reassigning clinics to labs would decrease the average sample turnaround time (TAT) by 11% and increase the number of infected infants starting treatment by about 4% relative to the current system. Furthermore, consolidating all diagnostic capacity in one centralized lab would decrease average TATs by an estimated 22% and increase the number of infected infants initiating treatment by 7%. Our sensitivity analysis suggests that the consolidation of capacity in a single location would remain near optimal across a wide range of laboratory utilization levels in Mozambique. However, this full consolidation solution is dominated by configurations with two or more labs for EID networks with average transportation times larger than those currently observed in Mozambique by at least 15%.

Suggested Citation

  • Jónas Oddur Jónasson & Sarang Deo & Jérémie Gallien, 2017. "Improving HIV Early Infant Diagnosis Supply Chains in Sub-Saharan Africa: Models and Application to Mozambique," Operations Research, INFORMS, vol. 65(6), pages 1479-1493, December.
    • Handle: RePEc:inm:oropre:v:65:y:2017:i:6:p:1479-1493
    DOI: 10.1287/opre.2017.1646
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