Researchers Develop New Models for Speeding Up HIV Testing

Researchers have developed new quantitative management models that could save the lives of thousands of early infants in Africa by improving the efficiency of laboratory test procedures now used to diagnose whether children were born with the deadly HIV virus.

Tens of thousands of children currently die each year of AIDS and 150,000 are infected with the human immunodeficiency virus (HIV) in sub-Saharan Africa, according to the latest UNAIDS data. So early diagnosis of HIV among infants born to HIV-infected mothers is deemed critical because roughly 50 percent of untreated infected infants die before the age of two years.

The researchers -- J�nas Oddur J�nasson of the MIT Sloan School of Management, Sarang Deo of the Indian School of Business and J�r�mie Gallien of the London School of Business -- reviewed data from 35,000 time-stamped lab samples in Mozambique, which showed that there are indeed significant delays in getting test results to and from diagnostic labs spread across the country -- and those delays of sometimes weeks and even months often lead to delays in critical early-stage treatments.

"Time is key when it comes to diagnosing and treating HIV in infants," said MIT's J�nasson. "Operational delays can be a matter of life and death for children."

In their new paper "Improving HIV Early Infant Diagnosis Supply Chain in Sub-Saharan Africa: Models and Application to Mozambique," the authors unveil two management models that they developed to improve the efficiency of laboratory testing for HIV in infants.

The first entailed making minor modifications to the current Early Infant Diagnosis (EID) networks in place in Mozambique. Leveraging the extensive dataset they show that simply reassigning some of the 400 health clinics to the handful of testing laboratories would decrease the average sample turnaround time (TAT) by 11 percent and increase the number of infected infants starting treatment by about 4 percent compared to the current system. These results were achieved without costly additional lab capacity.

Taking their modeling a step further, the researchers then turned their attention to whether relocating the existing testing machinery between labs, for example to a single centralized lab, would work better. Consolidation of diagnostic laboratories has been a much-debated issue within the health-care field for a number of years now in Africa.

The authors found that consolidating all diagnostic capacity in one centralized lab is the optimal configuration and would indeed decrease average TATs by an estimated 22 percent and increase the number of infected infants initiating treatment by 7 percent.

This somewhat counter-intuitive finding stems from the fact that, currently, many regional labs don't proceed with tests until they have enough samples to economically justify the use of valuable chemicals and other resources to conduct tests.

"In the end, we found that relatively cheap operational improvement can significantly shorten turnaround times and get infants on treatment who otherwise would not have survived," said J�nasson. "That's what it's all about: using operations management to improve global health."

The authors say their findings are applicable to other African nations dealing with AIDS and HIV infections, not just Mozambique.