PLoS One | November 2013
Background: There is scant evidence on the association between diagnosis delays and the receipt of test results in
HIV Early Infant Diagnosis (EID) programs. We determine the association between diagnosis delays and other health
care system and patient factors on result receipt.
Methods: We reviewed 703 infant HIV test records for tests performed between January 2008 and February 2009 at
a regional referral hospital and level four health center in Uganda. The main outcome was caregiver receipt of the
test result. The primary study variable was turnaround time (time between sample collection and result availability at
the health facility). Additional variables included clinic entry point, infant age at sample collection, reported HIV status
and receipt of antiretroviral prophylaxis for prevention of mother-to-child transmission. We conducted a pooled
analysis in addition to separate analyses for each facility. We estimated the relative risk of result receipt using
modified Poisson regression with robust standard errors.
Results: Overall, the median result turnaround time, was 38 days. 59% of caregivers received infant test results.
Caregivers were less likely to receive results at turnaround times greater than 49 days compared to 28 days or fewer
(ARR = 0.83; 95% CI = 0.70–0.98). Caregivers were more likely to receive results at the PMTCT clinic (ARR = 1.81;
95% CI = 1.40–2.33) and less likely at the pediatric ward (ARR = 0.54; 95% CI = 0.37–0.81) compared to the
immunization clinic. At the level four health center, result receipt was half as likely among infants older than 9 months
compared to 3 months and younger (ARR= 0.47; 95% CI = 0.25–0.93).
Conclusion: In this study setting, we find evidence that longer turnaround times, clinic entry point and age at sample
collection may be associated with receipt of infant HIV test results.
Sarang Deo is a Professor of Operations Management at the Indian School of Business (ISB), where he also serves as the Deputy Dean for Faculty and Research and as the Executive Director of the Max Institute of Healthcare Management (MIHM).
His primary area of research is health care delivery systems. He is interested in investigating the impact of operations decisions on population-level health outcomes. Some of the healthcare contexts that he has studied include the influenza vaccine supply chain and the phenomenon of ambulance diversion in the US, HIV early infant diagnosis networks in sub-Saharan Africa, and formal and informal pathways for tuberculosis (TB) diagnosis in India. He regularly collaborates with international public health funding and implementation agencies such as Bill & Melinda Gates Foundation (BMGF), Clinton Health Access Initiative (CHAI), and PATH for his research. He currently serves as a member of the WHO Strategic and Technical Advisory Group on TB (STAG-TB).
Prior to joining ISB, Professor Deo was an Assistant Professor at the Kellogg School of Management. He holds a PhD from UCLA Anderson School of Management, an MBA from Indian Institute of Management (IIM) Ahmedabad, and a B Tech from the Indian Institute of Technology (IIT) Bombay. Before entering academia, he worked with Accenture as a management consultant.
