title: Implementing and measuring the level of laboratory service integration in a program setting in Nigeria.
abstract: BACKGROUND
  The surge of donor funds to fight HIV&AIDS epidemic inadvertently resulted in the setup of laboratories as parallel structures to rapidly respond to the identified need. However these parallel structures are a threat to the existing fragile laboratory systems. Laboratory service integration is critical to remedy this situation. This paper describes an approach to quantitatively measure and track integration of HIV-related laboratory services into the mainstream laboratory services and highlight some key intervention steps taken, to enhance service integration.
  
  
  METHODS
  A quantitative before-and-after study conducted in 122 Family Health International (FHI360) supported health facilities across Nigeria. A minimum service package was identified including management structure; trainings; equipment utilization and maintenance; information, commodity and quality management for laboratory integration. A check list was used to assess facilities at baseline and 3 months follow-up. Level of integration was assessed on an ordinal scale (0 = no integration, 1 = partial integration, 2 = full integration) for each service package. A composite score grading expressed as a percentage of total obtainable score of 14 was defined and used to classify facilities (≤ 80% FULL, 25% to 79% PARTIAL and <25% NO integration). Weaknesses were noted and addressed.
  
  
  RESULTS
  We analyzed 9 (7.4%) primary, 104 (85.2%) secondary and 9 (7.4%) tertiary level facilities. There were statistically significant differences in integration levels between baseline and 3 months follow-up period (p<0.01). Baseline median total integration score was 4 (IQR 3 to 5) compared to 7 (IQR 4 to 9) at 3 months follow-up (p = 0.000). Partial and fully integrated laboratory systems were 64 (52.5%) and 0 (0.0%) at baseline, compared to 100 (82.0%) and 3 (2.4%) respectively at 3 months follow-up (p = 0.000).
  
  
  CONCLUSIONS
  This project showcases our novel approach to measure the status of each laboratory on the integration continuum.
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Henry
authors.initials: H
authors.lastname: Mbah
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Olubunmi Ruth
authors.initials: OR
authors.lastname: Negedu-Momoh
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Oluwasanmi
authors.initials: O
authors.lastname: Adedokun
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Patrick Anibbe
authors.initials: PA
authors.lastname: Ikani
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Oluseyi
authors.initials: O
authors.lastname: Balogun
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Olusola
authors.initials: O
authors.lastname: Sanwo
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Kingsley
authors.initials: K
authors.lastname: Ochei
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Maurice
authors.initials: M
authors.lastname: Ekanem
authors.affiliation: Family Health International (FHI-360), Garki-Abuja, Nigeria.
authors.forename: Kwasi
authors.initials: K
authors.lastname: Torpey
mesh_terms: D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007753:Laboratories / Q000458:organization & administration* / Q000592:standards; D009549:Nigeria; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D018511:Systems Integration