Driving Test Results for HIV Patients in Nigeria A private-sector solution for delivering test samples and results supports HIV/AIDS epidemic control

For patients living with HIV/AIDS (PLHIV), getting quick and accurate test results for viral load and other health indicators is essential, supporting the best course of treatment. Increasing access to viral load and other testing is also key to PEPFAR's (U.S. President's Emergency Plan for AIDS Response) aim to ensure treatment effectiveness and prevent HIV transmission. In Nigeria, nationwide investments in collecting and delivering blood samples and test results is making a difference for PLHIV.

Nigeria’s system for moving thousands of viral load samples and results between health facilities and laboratories relied on parallel and uncoordinated modes of transport, including the Nigeria postal system, PEPFAR implementing partners’ vehicles, and other commercial carriers.

At times lab personnel had to deliver test results to health centers, taking time away from their lab work.

Lack of adequate sample management and proper equipment to transport samples presented contamination risks for people and compromised sample quality. With test results taking on average six months, the results were of limited use in helping manage treatment.

Working with key donor agencies, the World Health Organization and other partners, Nigeria’s Ministry of Health established the National Integrated Specimen Referral Network (NiSRN) in March 2018 to provide a cost-effective, efficient, safe and secure specimen referral system that enables patients to access quality laboratory testing irrespective of their location in Nigeria. The USAID Global Health Supply Chain-Procurement and Supply Management (GHSC-PSM) project implemented NISRN on behalf of the Nigerian government using private-sector, third-party logistics providers to transport test samples and results to and from health facilities and testing laboratories. The program, funded through PEPFAR and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund), covers all 36 of Nigeria’s states and the Federal Capital Territory.

Through NiSRN, private sector partners provide a dedicated team of motorcycle couriers who are held accountable for timely pickup, transport, and delivery of blood and samples for viral load, early infant diagnosis, CD4 and sputum for tuberculosis diagnosis. All these tests are essential for patients with HIV.

The couriers pick up test samples from health facilities...

...and deliver them to designated laboratories using dedicated containers that prevent contamination and maintain an appropriate temperature to protect the samples from spoilage.

Medical laboratory scientists compare the delivered samples to the drivers’ logbooks and check to ensure the temperature in the sample box is within the acceptable range.

At the labs, the drivers pick up test results and deliver them back to the health facilities.

Through July 31, 2019, NiSRN has delivered 1 million samples for testing and returned 958,000 results.

The implementation of NiSRN activities started with 1,700 HIV/AIDS treatment sites. This has risen to 3,114 as of September 2018, including 2,172 supported by PEPFAR and 942 supported by the Global Fund. Viral load samples tested increased by 27 percent from 365,000 to 464,000 within the first six months of the program and continue to rise over time.

Patients, health care workers, and medical lab scientists are all seeing the results of the centrally coordinated program. Turnaround time for test results has dropped from, on average, six months to two weeks, giving medical staff the information they need to better support patients on treatment.

“Our patients are very happy with the turnaround time.” Desmond Ikebude, PCR focal person.
"The sample referral network has made things easier. We often have storage problems and erratic power supply, which make it difficult to store samples and the volume of samples makes it difficult to have test results returned on time. But now viral load results are promptly returned.” Dr. Alawode Olusegun
Photo credit: All photos by Anthony Abu

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