title: The centrality of laboratory services in the HIV treatment and prevention cascade: The need for effective linkages and referrals in resource-limited settings.
abstract: Strong laboratory services and systems are critical for delivering timely and quality health services that are vital to reduce patient attrition in the HIV treatment and prevention cascade. However, challenges exist in ensuring effective laboratory health systems strengthening and linkages. In particular, linkages and referrals between laboratory testing and other services need to be considered in the context of an integrated health system that includes prevention, treatment, and strategic information. Key components of laboratory health systems that are essential for effective linkages include an adequate workforce, appropriate point-of-care (POC) technology, available financing, supply chain management systems, and quality systems improvement, including accreditation. In this review, we highlight weaknesses of and gaps between laboratory testing and other program services. We propose a model for strengthening these systems to ensure effective linkages of laboratory services for improved access and retention in care of HIV/AIDS patients, particularly in low- and middle-income countries.
authors.affiliation: 1 Division of Global HIV/AIDS, Centers for Disease Control and Prevention Caribbean Regional Office , Barbados .
authors.forename: George
authors.initials: G
authors.lastname: Alemnji
authors.forename: Peter
authors.initials: P
authors.lastname: Fonjungo
authors.forename: Barbara
authors.initials: B
authors.lastname: Van Der Pol
authors.forename: Trevor
authors.initials: T
authors.lastname: Peter
authors.forename: Rami
authors.initials: R
authors.lastname: Kantor
authors.forename: John
authors.initials: J
authors.lastname: Nkengasong
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003906:Developing Countries; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D007753:Laboratories / Q000458:organization & administration*; D009313:National Health Programs / Q000458:organization & administration; D011314:Preventive Health Services / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration*
chemical_list: D019380:Anti-HIV Agents
references.citation: PLoS Med. 2011 Jul;8(7):e1001056
references.pmid: 21811403
references.citation: PLoS Med. 2007 Oct 16;4(10):e298
references.pmid: 17941716
references.citation: N Engl J Med. 2008 Nov 20;359(21):2233-44
references.pmid: 19020325
references.citation: PLoS One. 2011 Mar 15;6(3):e17842
references.pmid: 21423615
references.citation: MMWR Morb Mortal Wkly Rep. 2013 Mar 1;62(8):148-51
references.pmid: 23446514
references.citation: Bull World Health Organ. 2010 Jun;88(6):402
references.pmid: 20539847
references.citation: BMC Public Health. 2013 May 13;13:465
references.pmid: 23668880
references.citation: J Acquir Immune Defic Syndr. 2012 Aug 15;60 Suppl 3:S63-9
references.pmid: 22797742
references.citation: Trop Med Int Health. 2012 Apr;17(4):497-506
references.pmid: 22296265
references.citation: BMC Infect Dis. 2010 Nov 15;10:329
references.pmid: 21078148
references.citation: AIDS Patient Care STDS. 2008 Mar;22(3):195-204
references.pmid: 18290752
references.citation: Int J Tuberc Lung Dis. 2011 Dec;15(12):1663-9
references.pmid: 22118175
references.citation: Lancet. 2011 Oct 29;378(9802):1572-9
references.pmid: 21951656
references.citation: J Acquir Immune Defic Syndr. 2013 Apr 1;62(4):441-6
references.pmid: 23221982
references.citation: Lancet. 2009 Jan 3;373(9657):48-57
references.pmid: 19038438
references.citation: Am J Clin Pathol. 2009 Jun;131(6):875-86
references.pmid: 19461097
references.citation: Indian J Community Med. 2011 Apr;36(2):139-42
references.pmid: 21976800
references.citation: J Infect Dis. 2008 Sep 1;198(5):687-93
references.pmid: 18662132
references.citation: AIDS. 2007 Apr 23;21(7):851-60
references.pmid: 17415040
references.citation: Am J Clin Pathol. 2010 Sep;134(3):374-80
references.pmid: 20716792
references.citation: AIDS. 2007 Nov 30;21(18):2529-32
references.pmid: 18025890
references.citation: N Engl J Med. 2011 Aug 11;365(6):493-505
references.pmid: 21767103
references.citation: Indian J Med Res. 2011 Dec;134(6):779-86
references.pmid: 22310813
references.citation: Tanzan J Health Res. 2013 Apr;15(2):143-51
references.pmid: 26591719
references.citation: J Clin Virol. 2013 May;57(1):84-7
references.pmid: 23380659
references.citation: PLoS Med. 2012 Feb;9(2):e1001174
references.pmid: 22347816
references.citation: Lancet. 2008 Jun 28;371(9631):2148-50
references.pmid: 18586156
references.citation: Trans R Soc Trop Med Hyg. 2009 Jun;103(6):549-58
references.pmid: 18992905
references.citation: AIDS Behav. 2012 Feb;16(2):368-74
references.pmid: 21739285
references.citation: Curr Opin HIV AIDS. 2013 Jan;8(1):59-64
references.pmid: 23211779
references.citation: Trop Med Int Health. 2012 Dec;17(12):1426-31
references.pmid: 23113824