July 14, 2023
The health sector in Malawi was faced with a pressing backlog issue which saw 100,273 unprocessed HIV viral load samples. This hampered timely testing and treatment for clients and accumulated due to reagent stockouts and persistent power outages in the country. Prompt action was necessary to clear the backlog, as viral load testing is crucial in managing and monitoring HIV. In December 2022, the Center for International Health, Education, and Biosecurity (Ciheb) Malawi, a part of the University of Maryland, Baltimore's global health initiative, joined forces with the Ministry of Health (MoH) to address this issue. Together, they implemented a series of targeted interventions, showcasing the effectiveness of collaboration and strategic planning.
Key Interventions
- Expedited distribution of reagents: When reagents became available in the second week of December 2022, Ciheb Malawi, in coordination with MoH, ensured their rapid distribution to molecular laboratories. This prompt action enabled the immediate initiation of viral load testing.
- Testing capacity determination and sample transfers: To optimize efficiency, testing capacities were assessed for each laboratory, estimating the number of days required to clear the backlog based on sample volumes. Viral load samples were strategically transferred from laboratories with lower testing capacity to those with higher capacity. Central hospitals equipped with high throughput testing machines, such as Alinity m and Hologic, played a pivotal role in this process.
- Power backup support and 24-hour shift implementation: Recognizing the impact of power outages on uninterrupted testing, Ciheb Malawi provided fuel support for backup power in laboratories lacking stable power backup systems. Moreover, a significant intervention involved the implementation of a 24-hour shift in all molecular laboratories. This round-the-clock operation allowed for continuous testing and swift resolution of any challenges encountered.
- Continuous monitoring and staff deployment: Weekly monitoring of reagent stock status ensured timely redistribution where necessary, preventing service interruptions in high-volume molecular laboratories. Additionally, regular meetings with molecular laboratory staff were held to review progress, express appreciation for their efforts, and address any challenges hindering the smooth delivery of viral load testing. To maintain optimal staffing coverage, surge staff were deployed to facilities involved in testing viral load samples from other molecular laboratories, ensuring efficient operations during weekends, off-days, and public holidays.
Impact of Interventions
The impact these interventions had was remarkable. The expedited distribution of reagents enabled the prompt initiation of viral load testing while rationalizing sample volumes based on laboratory capacities accelerated the overall process. As a result, a total of 97,134 viral load samples were successfully tested, contributing to the clearance of the backlog within the designated 15-day timeframe.
The continuous monitoring of reagent stock status played a crucial role in preventing service interruptions in high-volume molecular laboratories. This proactive approach allowed for an additional 38,000 tests to be conducted between December 2022 and January 2023. Transportation support provided by Ciheb Malawi facilitated the allocation of 17,000 reagents to Hologic Panther machines and 21,000 reagents to Abbott m2000 machines.
Lessons Learned
These interventions provide valuable lessons for future initiatives. Continuous assessment of laboratory capacities, coupled with efficient sample transfers between facilities, can minimize or prevent the accumulation of unprocessed samples. Moreover, maintaining regular engagement with molecular laboratory staff is vital for monitoring testing progress and addressing any challenges that may arise along the way.
Contact
Center for International Health, Education, and Biosecurity
Institute of Human Virology
Anthony Okoth
Regional Communications Specialist
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