Abstract

Decreasing turnaround time for prenatal HIV and syphilis tests in the Dominican Republic

A. Castro¹, K. Przytula¹, C. Bautista², M. Heymann¹, K. Mate<sup>3

1</sup>Harvard Medical School, Global Health and Social Medicine, Boston, United States, ²COPRESIDA, Santo Domingo, Dominican Republic, ³Brigham & Women's Hospital, Global Health Equity, Boston, United States

Background: As a component of the Latin American and Caribbean Initiative for the Integration of Prenatal Care with the Testing and Treatment of HIV and Syphilis (ILAP), the Turnaround Time (TAT) Project was conducted in six health facilities in the Dominican Republic (DR). Its objective was to understand the flow of syphilis and HIV tests performed during pregnancy, measure TAT, and identify actions needed to shorten TAT. In the DR, the estimated prevalence of HIV in pregnant women in 2006 is 2.3%; coverage of PMTCT is 41%. Although more than 95% of pregnant women receive prenatal care, only 25.4% were tested for HIV; an estimated 1,558-3,896 newborns acquired HIV in 2005-2006. Estimated prevalence of maternal syphilis is 1.38-1.43%. Only 107 syphilis tests were performed among pregnant women in 2006, compared to 22,800 HIV tests.
Methods: TAT was measured in 2010 from the point a test is prescribed in the clinical record to the time the test result is recorded as having been provided to the patient. Qualitative data were collected using non-structured interviews to create flowcharts of the trajectories of blood specimens and test results. Delays at each step were quantified through chart review. TAT was analyzed using simple descriptive statistics. Data analysis was compiled into a report of strategies to shorten TAT?drawn from the experience of health professionals and their own suggestions when comparing the ideal and the actual flowcharts and when presenting them with the results of the TAT measurement.
Results: TAT measurements showed extensive delays in the processing of laboratory samples and obtaining results, which contribute to delayed treatment initiation, increased loss to follow up, and additional laboratory testing. Test results were often unavailable when women presented for labor.
Conclusions: Results that combine process (qualitative) and measurement (quantitative) data are essential to guide effective interventions in health care settings.