The Kwara state of west-central Nigeria suffers many health-related challenges: an HIV prevalence rate of 2.2 %, a large geographic area, difficult terrain, a rural population, poor access to health facilities, long waiting time at facilities, and shortages of human resources for health. These are some of the factors thought to contribute to poor uptake of HIV testing and CD4 investigation (a test to determine whether or not a patient is eligible for HIV treatment) and the high level of attrition of patients living with HIV at all stages of the treatment process — from HIV testing to commencement of treatment to long-term treatment.
Enter Chioma Nwuba, laboratory specialist with the Prevention and Organizational Systems – AIDS Care and Treatment Project (ProACT) in Kwara state to the XIX International AIDS Conference. On Wednesday, July 25, Chioma presented “A laboratory-based approach to reduce loss to follow-up of HIV positive clients” to a standing-room only crowd at the oral abstract session on HIV linkage retention in care. She described the “MSH” leadership and management approach used by the ProACT project: The hospital management committee assessed the situation and made decisions that ultimately streamlined service delivery at the facility — ensuring sustainability and local ownership.
Thanks to the intervention: data clerks now fill laboratory request forms instead of clinicians; lab technicians collect and test blood rather than clinicians; escort services are strengthened so patients are enrolled and undergo lab tests on the same day; lab tests are provided Monday through Friday rather than just once a week; and test results are provided quickly to ensure initiation on treatment.
Twelve months after the intervention, the number of clients accessing CD4 investigations increased from 53.8% to 93.3%, the number of clients lost along the treatment process reduced from 58.7% to 10.7%, turnaround time for certain test results decreased from 7 days to 24 hours and the average client wait time decreased from 4 to 1.5 hours.
The project staff have found that strengthening laboratory systems helps increase uptake of CD4 investigations, shorten client waiting time and ultimately reduces loss-to-follow-up, especially among clients attending clinics from hard to reach communities with difficult terrains.
ProACT is a five-year, 60-million-dollar, follow-on project to the Nigeria Leadership Management and Sustainability (LMS) AIDS Care and Treatment Project (LMS-ACT). ProACT supports HIV & AIDS and TB services in six Nigerian states: Kogi, Niger, Kwara, Kebbi, Taraba, and Adamawa. The project places a strong emphasis on building the capacity of government and civil society organizations to strengthen health and HIV & AIDS systems for delivery of integrated health and HIV & AIDS and TB services.