Journal of Acquired Immune Deficiency Syndromes | September 2015
Late delivery of test results is likely to be associated with patient loss to follow-up in HIV early infant diagnosis (EID) programs in resource-limited settings.
Methods: We used EID program data collected during a pilot implementation of an expedited results delivery system(ERDS) using GPRS printers in Mozambique from 2009 through 2010. Our dataset comprised 1,757 patient records, of which 767 were from before and 990 from after implementation of ERDS.We used multivariate logistic regression model to determine the association between late result delivery (more than 30 days between sample collection and result delivery to the health facility) and the probability of result collection by the infant's caregiver. We used a sample selection model to determine the association between late result delivery to the facility and further delay in collectionof results by the caregiver.
Results:The mean test turnaround timereduced from 68.13 to 41.05 days post-ERDS. Of the 1,757 results, only 665 (37.8%) were collected by caregivers.After controlling for confounders, the late delivery of resultswas associated with a reduction of approximately 18% (0.44 vs. 0.36; p-value<0.01) in the probability of results collected by thecaregivers (OR=0.67, p-value<0.05). Late delivery of results was also associated with a further average increase in 20.91 daysof delay in collection of results (p-value<0.01).
Conclusions: Late delivery of results is associated with lower probability of them being collected and a further increase in communication delay. EID programs should further evaluate the cost-effectiveness of operational interventions(e.g. GPRS printers) that reduce delays.
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.
