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Clinical/Laboratory Interface Interventions to Improve Impact of Viral Load and Early Infant Diagnosis Testing
George Alemnji1,2, Rituparna Pati1, Helen Chun1
1Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Improving viral load (VL) and early infant diagnosis (EID) testing requires engaging people living with HIV and strengthening clinical-laboratory collaboration. Addressing communication gaps and implementing best practices are crucial for optimizing HIV testing and patient management.
Area of Science:
- Public Health
- Infectious Diseases
- HIV/AIDS Management
Background:
- Viral load (VL) monitoring and early infant diagnosis (EID) are critical for managing HIV/AIDS.
- Despite improvements, low testing rates and suboptimal VL suppression persist in certain populations and regions.
- Gaps in the VL/EID cascade, particularly between clinical and laboratory services, hinder effective patient care.
Purpose of the Study:
- To identify barriers and facilitators within the VL/EID cascade.
- To propose strategies for optimizing VL/EID scale-up and improving HIV care.
- To enhance the clinical-laboratory interface for better patient outcomes.
Main Methods:
- Review of the VL/EID cascade components and their interrelationships.
- Analysis of communication and coordination gaps between clinical and laboratory teams.
- Identification of best practices and innovative solutions for strengthening the cascade.
Main Results:
- Patient and provider demand creation is essential for increasing VL/EID testing.
- Strong clinical-laboratory communication, collaboration, and joint performance reviews are vital.
- Gaps in sample transport, results transmission, and patient management negatively impact outcomes.
Conclusions:
- Engaging communities and strengthening the clinical-laboratory interface are key to optimizing VL/EID programs.
- Implementing point-of-care diagnostics, simplified data systems, and efficient supply chains can bridge interface gaps.
- Continuous quality improvement and collaborative efforts are necessary for sustained progress in HIV viral load monitoring and EID.
Abstract:
Despite tremendous improvements in viral load (VL) monitoring and early infant diagnosis (EID) in many countries, low VL and EID testing rates and low VL suppression rates persist in specific regions and among certain subpopulations. The VL/EID cascade includes patient and provider demand creation, sample collection and transportation, laboratory testing, results transmission back to the clinic, and patient management. Gaps in communication and coordination between clinical and laboratory counterparts can lead to suboptimal outcomes, such as delay or inability to collect and transport samples to the laboratory for testing and failure of test results to reach providers and patients in an efficient, timely, and effective manner. To bridge these gaps and optimize the impact of VL/EID scale-up, we reviewed the components of the cascade and their interrelationships to identify barriers and facilitators. As part of this process, people living with HIV must be engaged in creating demand for VL/EID testing. In addition, there should be strong communication and collaboration between the clinical and laboratory teams throughout the cascade, along with joint performance review, site visits, and continuous quality improvement activities. Strengthening the clinical/laboratory interface requires innovative solutions and implementation of best practices, including the use of point-of-care diagnostics, simplified data systems, and an efficient supply chain system to minimize interface gaps.
