Optimizing Courier Specimen Collection Time Improves Patient Access to Viral Load Testing in South Africa

Background: South Africa uses a courier network for transporting specimens to public laboratories. After specimens have been collected from the facility by the courier for the day, patients not yet attended to are unlikely to receive same-day blood-draw, potentially inhibiting access to essential diagnostics, including viral load (VL) testing for human immunodeficiency virus (HIV) patients .We aimed to design an optimized courier network and assess whether this improves VL testing access.  Methods: We first optimized the specimen transport network in South Africa for 4,046 facilities. The facilities for which we have current specimen transport time (n=356), we used regression to assess the relationship between specimen transport time and VL testing access (number of annual VL tests/antiretroviral treatment (ART) patients). We compared our optimized transport times with courier collection times to determine the change in access to same-day blood-draws. Findings: The number of annual VL tests/ART patient (1·14, standard deviation (SD) 0·02) was higher at facilities that have courier collection after 13:36 (the average latest collection time) than those that had collection before 13:36 (1·06, SD 0·03), even when adjusted for facility size. Through network optimization, the average time for specimen transport was delayed to 14:35, resulting in a 6%-13% increase in patient access to blood-draws. Interpretation: VL testing access is dependent upon the time of courier collection at healthcare facilities. Optimizing courier collection times at facilities can improve patient access to VL testing. Simple solutions are frequently overlooked in our quest for improving the health of populations. We demonstrate how simply changing specimen transportation timing could markedly improve the proportion of patients with access to diagnostic testing services. Funding: This project has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of CoAg 5 NU2GGH001631-04-00. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This project was approved by the University of Witwatersrand Human Research Ethics Committee (Medical) (HREC) as an additional project within the Integrated Laboratory Data Analysis for Care (ILDAC) program (HREC M160978). Additional ethics approval was received from the Center for Global Health, United States Centers for Disease Control and Prevention in Atlanta (CGH 2019-224).