Integration of HIV & AIDS Laboratory Services in Rural Nigerian Clinics Produces Results
The sudden rapid scale up of HIV & AIDS service delivery in Nigeria has led to the strengthening of HIV-related laboratories, instead of the general laboratory health systems. It is not uncommon to see a newly constructed, well-staffed HIV laboratory side-by-side with a crumbling general laboratory.
The HIV laboratories have better human and material resources, and enhanced working conditions compared to the existing general laboratories. This has led to a lack of uniformity in the quality of services offered at different units in many laboratories, and has created resentment among health workers.
Management Sciences for Health (MSH), through the USAID-funded Prevention and Organizational Systems – AIDS Care and Treatment Project (Pro-ACT) project, provides support for HIV care and treatment services at 25 comprehensive care and treatment sites. MSH, in partnership with the governments of Kwara and Taraba States, has integrated HIV & AIDS lab services into existing general laboratory systems.
Pro-ACT helps integrate services by:
- Situating HIV laboratories in the same buildings as general hospital laboratories;
- Rehabilitating existing general laboratory infrastructures rather than erecting new HIV & AIDS lab structures;
- Building lab services capacity for all categories of staff, irrespective of the laboratory unit where they work;
- Providing training on good clinical laboratory practice, automation, and quality assurance processes for all laboratory units; and,
- Conducting quality assurance review meetings for all lab staff to evaluate quality of services provided to all patients, irrespective of their HIV status.
These Pro-ACT-supported laboratories showed a significant improvement in the number of laboratory test results generated, from 32.5% in 2009 to 74.2% in 2010. Compliance with established quality assurance guidelines on record keeping, safety precautions and corrective actions have also improved.
Quality assurance review meetings are held monthly and provide a forum for all lab staff to meet, discuss challenges, have access to continuing medical education, and draw up plans for increased productivity. These meetings have resulted in harmonized linkages between services in the laboratory, improved patient flow, and reduced client waiting time.
In addition, stigma has been reduced because HIV positive clients are attended to at the same service points as other patients and by any laboratory personnel on duty rather than by a separate group of HIV & AIDS services staff.
A survey of clients assessing care and treatment services at the rural clinics where these interventions took place revealed that integration of HIV services into routine laboratory services has greatly improved confidentiality and has increased use of laboratory services by persons living with HIV.
The integration of HIV & AIDS services into existing government laboratories has proven to be an effective strategy for laboratory systems strengthening.