IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0221586.html
   My bibliography  Save this article

Optimizing viral load testing access for the last mile: Geospatial cost model for point of care instrument placement

Author

Listed:
  • Sarah J Girdwood
  • Brooke E Nichols
  • Crispin Moyo
  • Thomas Crompton
  • Dorman Chimhamhiwa
  • Sydney Rosen

Abstract

Introduction: Viral load (VL) monitoring programs have been scaled up rapidly, but are now facing the challenge of providing access to the most remote facilities (the “last mile”). For the hardest-to-reach facilities in Zambia, we compared the cost of placing point of care (POC) viral load instruments at or near facilities to the cost of an expanded sample transportation network (STN) to deliver samples to centralized laboratories. Methods: We extended a previously described geospatial model for Zambia that first optimized a STN for centralized laboratories for 90% of estimated viral load volumes. Amongst the remaining 10% of volumes, facilities were identified as candidates for POC placement, and then instrument placement was optimized such that access and instrument utilization is maximized. We evaluated the full cost per test under three scenarios: 1) POC placement at all facilities identified for POC; 2)an optimized combination of both on-site POC placement and placement at facilities acting as POC hubs; and 3) integration into the centralized STN to allow use of centralized laboratories. Results: For the hardest-to-reach facilities, optimal POC placement covered a quarter of HIV-treating facilities. Scenario 2 resulted in a cost per test of $39.58, 6% less than the cost per test of scenario 1, $41.81. This is due to increased POC instrument utilization in scenario 2 where facilities can act as POC hubs. Scenario 3 was the most costly at $53.40 per test, due to high transport costs under the centralized model ($36 per test compared to $12 per test in scenario 2). Conclusions: POC VL testing may reduce the costs of expanding access to the hardest-to-reach populations, despite the cost of equipment and low patient volumes. An optimal combination of both on-site placement and the use of POC hubs can reduce the cost per test by 6–35% by reducing transport costs and increasing instrument utilization.

Suggested Citation

  • Sarah J Girdwood & Brooke E Nichols & Crispin Moyo & Thomas Crompton & Dorman Chimhamhiwa & Sydney Rosen, 2019. "Optimizing viral load testing access for the last mile: Geospatial cost model for point of care instrument placement," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-13, August.
  • Handle: RePEc:plo:pone00:0221586
    DOI: 10.1371/journal.pone.0221586
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221586
    Download Restriction: no

    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0221586&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pone.0221586?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. V Habiyambere & B Dongmo Nguimfack & L Vojnov & N Ford & J Stover & L Hasek & P Maggiore & D Low-Beer & M Pérez Gonzàlez & D Edgil & J Williams & J Kuritsky & S Hargreaves & T NeSmith, 2018. "Forecasting the global demand for HIV monitoring and diagnostic tests: A 2016-2021 analysis," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-14, September.
    2. Alastair Heffernan & Ella Barber & Ranjeeta Thomas & Christophe Fraser & Michael Pickles & Anne Cori, 2016. "Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-12, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Elizabeth R Stevens & Lingfeng Li & Kimberly A Nucifora & Qinlian Zhou & Margaret L McNairy & Averie Gachuhi & Matthew R Lamb & Harriet Nuwagaba-Biribonwoha & Ruben Sahabo & Velephi Okello & Wafaa M E, 2018. "Cost-effectiveness of a combination strategy to enhance the HIV care continuum in Swaziland: Link4Health," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-17, September.
    2. Robert Luo & Jessica Markby & Jilian Sacks & Lara Vojnov, 2019. "Systematic review of the accuracy of plasma preparation tubes for HIV viral load testing," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-10, November.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0221586. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.