Implementation of Point-of-Care Diagnostics Leads to Variable Uptake of Syphilis, Anemia and CD4+ T-Cell Count Testing in Rural Maternal and Child Health Clinics.

INTRODUCTION: Anemia, syphilis and HIV are high burden diseases among pregnant women in sub-Saharan Africa. A quasi-experimental study was conducted in four health facilities in Southern Mozambique to evaluate the effect of point-of-care technologies for hemoglobin quantification, syphilis testing and CD4+ T-cell enumeration performed within maternal and child health services on testing and treatment coverage, and assessing acceptability by health workers. METHODS: Demographic and testing data on women attending first antenatal care services were extracted from existing records, before (2011; n = 865) and after (2012; n = 808) introduction of point-of-care testing. Study outcomes per health facility were compared using z-tests (categorical variables) and Wilcoxon rank-sum test (continuous variables), while inverse variance weights were used to adjust for possible cluster effects in the pooled analysis. A structured acceptability-assessment interview was conducted with health workers before (n = 22) and after (n = 19). RESULTS: After implementation of point-of-care testing, there was no significant change in uptake of overall hemoglobin screening (67.9% to 83.0%; p = 0.229), syphilis screening (80.8% to 87.0%; p = 0.282) and CD4+ T-cell testing (84.9% to 83.5%; p = 0.930). Initiation of antiretroviral therapy for treatment eligible women was similar in the weighted analysis before and after, with variability among the sites. Time from HIV diagnosis to treatment initiation decreased (median of 44 days to 17 days; p CONCLUSIONS: Point-of-care CD4+ T-cell enumeration resulted in a decreased time to initiation of antiretroviral therapy among treatment eligible women, without significant increase in testing coverage. Overall hemoglobin and syphilis screening increased. Despite the perception that point-of-care technologies increase access to health services, the variability in results indicate the potential for detrimental effects in some settings. Local context needs to be considered and services restructured to accommodate innovative technologies in order to improve service delivery to expectant mothers

Projeto de Melhoria da Qualidade Laboratorial para Países de Língua Portuguesa (2015-2019)

A Lei de Bases da Saúde incentiva a cooperação internacional com Países de Língua Portuguesa na melhoria dos cuidados de saúde, educação, investigação e pesquisa em saúde, a fim de garantir o direito à proteção da saúde humana. A qualidade dos serviços prestados pelos laboratórios clínicos é crucial na prestação de cuidados de saúde, fornecendo informações para as melhores decisões médicas. O Projeto de Melhoria da Qualidade Laboratorial para Países de Língua Portuguesa (ProMeQuaLab), lançado em 2015, é um projeto de colaboração no âmbito da melhoria da Qualidade Laboratorial entre representantes dos diferentes países onde o Português é o idioma oficial. O objetivo do projeto é desenvolver capacidade para implementar e sustentar boas práticas laboratoriais, a fim de melhorar a qualidade dos laboratórios médicos, visando o diagnóstico e tratamento adequados dos doentes. Necessidade da manutenção da realização das visitas aos laboratórios nos diferentes países permitindo a constatação da realidade reportada nas respostas dos questionários. Grande disparidade ao nível dos equipamentos, reagentes e na implementação do controlo da qualidade. Falta significativa de conhecimento sobre controlo interno da qualidade e avaliação externa da qualidade. A metodologia do projeto revelou-se eficaz, uma vez que no último congresso verificámos a aplicação pelos participantes das ferramentas de CQ propostas. É necessário incentivar outros países de língua portuguesa a integrarem o grupo executivo e motivá-los a assumir o cargo de supervisor do projeto. A submissão de pedido para apoio financeiro é essencial para permitir a continuação da implementação contínua desta estratégia educacional e desenvolvimento de ferramentas eficazes de formação. Organização do 4º Congresso em Cabo Verde em 2021N/

External Quality Assessment Programme for Early Infant Diagnosis of HIV-1, Mozambique, 2011–2014

This study evaluated a National External Quality Scheme Program for early infant diagnosis of HIV. Fourteen laboratory technicians participated and nine testing panel cycles were sent between 2011 and 2014. The response rate was 100% for the first eight panels, and the number of technicians with a test score of 100% increased during the first three panels. Based on the evaluations of the technicians, the quality of testing for early infant diagnosis of HIV improved over time in the laboratories

Implementation of Point-of-Care Diagnostics Leads to Variable Uptake of Syphilis, Anemia and CD4+ T-Cell Count Testing in Rural Maternal and Child Health Clinics

Introduction: Anemia, syphilis and HIV are high burden diseases among pregnant women in sub-Saharan Africa. A quasi-experimental study was conducted in four health facilities in Southern Mozambique to evaluate the effect of point-of-care technologies for hemoglobin quantification, syphilis testing and CD4+ T-cell enumeration performed within maternal and child health services on testing and treatment coverage, and assessing acceptability by health workers. Methods: Demographic and testing data on women attending first antenatal care services were extracted from existing records, before (2011; n = 865) and after (2012; n = 808) introduction of point-of-care testing. Study outcomes per health facility were compared using z-tests (categorical variables) and Wilcoxon rank-sum test (continuous variables), while inverse variance weights were used to adjust for possible cluster effects in the pooled analysis. A structured acceptability-assessment interview was conducted with health workers before (n = 22) and after (n = 19). Results: After implementation of point-of-care testing, there was no significant change in uptake of overall hemoglobin screening (67.9% to 83.0%; p = 0.229), syphilis screening (80.8% to 87.0%; p = 0.282) and CD4+ T-cell testing (84.9% to 83.5%; p = 0.930). Initiation of antiretroviral therapy for treatment eligible women was similar in the weighted analysis before and after, with variability among the sites. Time from HIV diagnosis to treatment initiation decreased (median of 44 days to 17 days; p\u3c0.0001). A generally good acceptability for point-of-care testing was seen among health workers. Conclusions: Point-of-care CD4+ T-cell enumeration resulted in a decreased time to initiation of antiretroviral therapy among treatment eligible women, without significant increase in testing coverage. Overall hemoglobin and syphilis screening increased. Despite the perception that point-of-care technologies increase access to health services, the variability in results indicate the potential for detrimental effects in some settings. Local context needs to be considered and services restructured to accommodate innovative technologies in order to improve service delivery to expectant mothers

Quality assurance for point-of-care testing in Mozambique’s National Health Service

No abstract available

Mozambique’s journey toward accreditation of the National Tuberculosis Reference Laboratory

Background: Internationally-accredited laboratories are recognised for their superior test reliability, operational performance, quality management and competence. In a bid to meet international quality standards, the Mozambique National Institute of Health enrolled the National Tuberculosis Reference Laboratory (NTRL) in a continuous quality improvement process towards ISO 15189 accreditation. Here, we describe the road map taken by the NTRL to achieve international accreditation. Methods: The NTRL adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a strategy to implement a quality management system. After SLMTA, the Mozambique National Institute of Health committed to accelerate the NTRL’s process toward accreditation. An action plan was designed to streamline the process. Quality indicators were defined to benchmark progress. Staff were trained to improve performance. Mentorship from an experienced assessor was provided. Fulfilment of accreditation standards was assessed by the Portuguese Accreditation Board. Results: Of the eight laboratories participating in SLMTA, the NTRL was the best-performing laboratory, achieving a 53.6% improvement over the SLMTA baseline conducted in February 2011 to the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) assessment in June 2013. During the accreditation assessment in September 2014, 25 minor nonconformities were identified and addressed. In March 2015, the NTRL received Portuguese Accreditation Board recognition of technical competency for fluorescence smear microscopy, and solid and liquid culture. The NTRL is the first laboratory in Mozambique toachieve ISO 15189 accreditation. Conclusions: From our experience, accreditation was made possible by institutional commitment, strong laboratory leadership, staff motivation, adequate infrastructure and a comprehensive action plan

Acceptability of POC tests performed at MCH by MCH nurses (n = 33) and laboratory technicians (n = 8), perceived pre-POC and actual post-POC implementation at MCH.

<p><i>POC- Point-of-Care; IQR—Interquartile Range; MCH—maternal and child health</i></p><p>¹ Fisher Exact’s Chi square test;</p><p>²Questions asked only to MCH nurses</p><p>Acceptability of POC tests performed at MCH by MCH nurses (n = 33) and laboratory technicians (n = 8), perceived pre-POC and actual post-POC implementation at MCH.</p

Cascade HIV/ART services for HIV positive pregnant women, pre-and post-introduction of POC CD4+ T-cell count.

<p>Cascade HIV/ART services for HIV positive pregnant women, from time of registration of HIV status to ART initiation, pre-(2010) and post-(2012) introduction of the point-of-care testing for CD4+ T-cell enumeration performed at the maternal and child health services. All proportions are calculated with the denominator being the number of women diagnosed with HIV. Eligibility for ART is defined as CD4+ T-cell count <351cells/μL. PW—Pregnant Women; ART—Antiretroviral Treatment.</p

Characteristics of the study population (n = 1673).

<p>* Chi-square test for comparison of categorical variables; Wilcoxon test for continuous variables</p><p>Characteristics of the study population (n = 1673).</p

Characteristics of the study health facilities.

<p>POC—Point-of-Care; ANC—Antenatal Care; MCH—Maternal and child health; ART—Antiretroviral therapy; HF—Health Facility</p><p>Characteristics of the study health facilities.</p