title: Specimen origin, type and testing laboratory are linked to longer turnaround times for HIV viral load testing in Malawi.
abstract: BACKGROUND
  Efforts to reach UNAIDS' treatment and viral suppression targets have increased demand for viral load (VL) testing and strained existing laboratory networks, affecting turnaround time. Longer VL turnaround times delay both initiation of formal adherence counseling and switches to second-line therapy for persons failing treatment and contribute to poorer health outcomes.
  
  
  METHODS
  We utilized descriptive statistics and logistic regression to analyze VL testing data collected in Malawi between January 2013 and March 2016. The primary outcomes assessed were greater-than-median pretest phase turnaround time (days elapsed from specimen collection to receipt at the laboratory) and greater-than-median test phase turnaround time (days from receipt to testing).
  
  
  RESULTS
  The median number of days between specimen collection and testing increased 3-fold between 2013 (8 days, interquartile range (IQR) = 6-16) and 2015 (24, IQR = 13-39) (p<0.001). Multivariable analysis indicated that the odds of longer pretest phase turnaround time were significantly higher for specimen collection districts without laboratories capable of conducting viral load tests (adjusted odds ratio (aOR) = 5.16; 95% confidence interval (CI) = 5.04-5.27) as well as for Malawi's Northern and Southern regions. Longer test phase turnaround time was significantly associated with use of dried blood spots instead of plasma (aOR = 2.30; 95% CI = 2.23-2.37) and for certain testing months and testing laboratories.
  
  
  CONCLUSIONS
  Increased turnaround time for VL testing appeared to be driven in part by categorical factors specific to the phase of turnaround time assessed. Given the implications of longer turnaround time and the global effort to scale up VL testing, addressing these factors via increasing efficiencies, improving quality management systems and generally strengthening the VL spectrum should be considered essential components of controlling the HIV epidemic.
authors.affiliation: Laboratory Leadership Service assigned to Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Peter A
authors.identifier: http://orcid.org/0000-0002-6295-0998
authors.initials: PA
authors.lastname: Minchella
authors.affiliation: Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Chipungu
authors.affiliation: Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kim
authors.affiliation: Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Sarr
authors.affiliation: Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Hammad
authors.initials: H
authors.lastname: Ali
authors.affiliation: Ministry of Health, Lilongwe, Malawi.
authors.forename: Reuben
authors.initials: R
authors.lastname: Mwenda
authors.affiliation: Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: John N
authors.initials: JN
authors.lastname: Nkengasong
authors.affiliation: Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi.
authors.forename: Daniel
authors.initials: D
authors.lastname: Singer
mesh_terms: D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008295:Malawi; D025202:Molecular Diagnostic Techniques; D013997:Time Factors; D019562:Viral Load