Programmatic implications of implementing the relational algebraic capacitated location (RACL) algorithm outcomes on the allocation of laboratory sites, test volumes, platform distribution and space requirements.

Abstract

Introduction: The National Health Laboratory Service (NHLS) of South Africa provides national coordination of laboratory services. CD4 testing is based on an integrated tiered service delivery model (ITSDM) that matches testing demand with capacity. Currently, the NHLS has predominantly implemented laboratory based CD4 testing (tiers 4 and 5). An objective methodology was required to identify coverage gaps, over/under capacitation and optimal placement of point of care (POC) testing sites.

Objectives: To assess the impact of a relational algebraic capacitated location (RACL) algorithm outcome on the allocation of laboratory sites, test volumes, platform distribution and space requirements.

Methods: The RACL algorithm was developed to efficiently allocate laboratories and POC sites to ensure coverage using a set coverage approach for a defined travel time (T). The algorithm was repeated for three scenarios (A: T=4, B: T=3 and C: T=2 hours). Drive times for a representative sample of health facility clusters were used to approximate T. The algorithm outcomes included the allocation of testing sites, Euclidian distances and test volumes. The analysis included the allocation of laboratory and POC sites, test volumes, platform distribution and space requirements. Each scenario was reported as a fusion table map.

Results: Scenario A would offer a fully centralised approach with 15 CD4 laboratories (closure of CD4 testing at 44 laboratories) without any POC testing. A significant increase in volumes would result in a 4-fold increase at busier laboratories. CD4 laboratories would be increased to 41 and 61 in scenarios B and C respectively. POC testing would be offered at 2 and 20 sites respectively. Scenario B and C laboratory test volumes would be similar to current volumes with significant decentralisation in rural areas.

Conclusion: The RACL algorithm provides an objective methodology to address coverage gaps through the allocation of CD4 laboratories and POC sites for a given T. The algorithm outcome needs to be assessed in the context of local conditions to address coverage gaps in a sustainable manner. Additionally, a tier 3 pilot highlights the ability of rural laboratories to improve coverage cost effectively.

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ORCID for Honora Smith: orcid.org/0000-0002-4974-3011

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