ArticlePloS one2019
Optimizing viral load testing access for the last mile: Geospatial cost model for point of care instrument placement.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Trial
- A Randomized Trial of Point-of-Care Early Infant Human Immunodeficiency Virus (HIV) Diagnosis in Zambia.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Trial
- Engaging Mentor Mothers in Rapid Return of Viral Load Results to Pregnant and Postpartum Women Living with HIV: An Implementation Pilot Study.AIDS and behavior · 2026Article
- Closing Diagnostic Gaps in Pediatric HIV: Innovations in Point-of-Care and Digital Monitoring with an Asia-Pacific Implementation Lens-A Systematic Review.Diagnostics (Basel, Switzerland) · 2026Review
- A maximal-coverage approach to prioritizing newborn sickle cell screening sites in Uganda using a sickle cell-malaria co-risk surface.Malaria journal · 2026Article
- Cost and impact of decentralized tuberculosis testing: a modeling analysis of price thresholds for molecular instruments in high-burden settings.EClinicalMedicine · 2026Article
- Using queueing models as a decision support tool in allocating point-of-care HIV viral load testing machines in Kisumu County, Kenya.Health policy and planning · 2024Article
- Verification of dried blood spot as a sample type for HIV viral load and early infant diagnosis on Hologic Panther in Zambia.BMC research notes · 2023Article
- Decentralization of viral load testing to improve HIV care and treatment cascade in rural Tanzania: observational study from the Kilombero and Ulanga Antiretroviral Cohort.BMC infectious diseases · 2023Observational
- Application of diagnostic network optimization in Kenya and Nepal to design integrated, sustainable and efficient bacteriology and antimicrobial resistance surveillance networks.PLOS global public health · 2023Article
- SARS-CoV-2 diagnostic testing rates determine the sensitivity of genomic surveillance programs.Nature genetics · 2023Article
- SARS-CoV-2 diagnostic testing rates determine the sensitivity of genomic surveillance programs.medRxiv : the preprint server for health sciences · 2022Article
- Use of Physical Accessibility Modelling in Diagnostic Network Optimization: A Review.Diagnostics (Basel, Switzerland) · 2022Review
- Optimising courier specimen collection time improves patient access to HIV viral load testing in South Africa.African journal of laboratory medicine · 2022Article
- Cost-effectiveness of point-of-care testing with task-shifting for HIV care in South Africa: a modelling study.The lancet. HIV · 2021Article
- Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya.Diagnostics (Basel, Switzerland) · 2021Article
- Evaluation of near point-of-care viral load implementation in public health facilities across seven countries in sub-Saharan Africa.Journal of the International AIDS Society · 2021Article
- HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential.Southern African journal of HIV medicine · 2021Article
- Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions.Diagnostics (Basel, Switzerland) · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionViral load (VL) monitoring programs have been scaled up rapidly, but are now facing the challenge of providing access to the most remote facilities (the "last mile"). For the hardest-to-reach facilities in Zambia, we compared the cost of placing point of care (POC) viral load instruments at or near facilities to the cost of an expanded sample transportation network (STN) to deliver samples to centralized laboratories.
methodsWe extended a previously described geospatial model for Zambia that first optimized a STN for centralized laboratories for 90% of estimated viral load volumes. Amongst the remaining 10% of volumes, facilities were identified as candidates for POC placement, and then instrument placement was optimized such that access and instrument utilization is maximized. We evaluated the full cost per test under three scenarios: 1) POC placement at all facilities identified for POC; 2)an optimized combination of both on-site POC placement and placement at facilities acting as POC hubs; and 3) integration into the centralized STN to allow use of centralized laboratories.
resultsFor the hardest-to-reach facilities, optimal POC placement covered a quarter of HIV-treating facilities. Scenario 2 resulted in a cost per test of $39.58, 6% less than the cost per test of scenario 1, $41.81. This is due to increased POC instrument utilization in scenario 2 where facilities can act as POC hubs. Scenario 3 was the most costly at $53.40 per test, due to high transport costs under the centralized model ($36 per test compared to $12 per test in scenario 2).
conclusionsPOC VL testing may reduce the costs of expanding access to the hardest-to-reach populations, despite the cost of equipment and low patient volumes. An optimal combination of both on-site placement and the use of POC hubs can reduce the cost per test by 6-35% by reducing transport costs and increasing instrument utilization.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.