Laboratory Services in the context of Prevention of Mother-to-Child Transmission of HIV testing requirements in Copperbelt Province, Zambia. A qualitative inquiry

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Abstract IntroductionReliable and timely laboratory results are crucial for monitoring the Prevention of Mother-to-Child Transmission (PMTCT) cascade, particularly to enable early HIV diagnosis and early intervention. We sought to explore whether and how laboratory services have been prepared to absorb new testing requirements following PMTCT Test-and-Treat policy changes in three districts of Zambia.MethodThis qualitative study was conducted in three local government areas in the Copperbelt Province (one urban and two rural) between February 2019 and July 2020. Document review and in-depth interviews with 26 purposively sampled health workers were undertaken. All interviews were analyzed using thematic data analysis, informed by the health system dynamic framework.ResultsThe findings revealed that the health system inputs (infrastructure and supplies, human resources, knowledge and information and finance) and service delivery were unequal between the rural and urban sites and this affected the ability of health facilities to apply the new testing requirements, especially, in the rural based health facilities. The major barriers identified include gaps in the capacity of the existing laboratory system to perform crucial PMTCT clinical and surveillance functions in a coordinated manner and insufficient skilled human resources to absorb the increased testing demands. The centralized laboratory system for HIV testing of mothers and exposed neonates meant facilities had to send specimens to other facilities and districts which resulted in high turnaround time and hence delayed HIV diagnosis.ConclusionNew guidelines implemented without sufficient capacitation of health system inputs and service delivery resulted in gaps in the capacity of the existing laboratory system to perform and meet the diagnostic and treatment needs for PMTCT. This study documented the areas relating to health system inputs and laboratory service delivery where greater investment and support is needed to enable absorption of the new testing requirements.

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