Number of testing facilities (laboratories) with capacity to perform clinical laboratory tests

Export Indicator

Number of testing facilities (laboratories) with capacity to perform clinical laboratory tests
What it measures

Countries are encouraged to monitor the numbers of laboratories doing HIV/AIDS related testing and the capacity of these laboratories. This effort seeks to evaluate USG support for laboratory capacity that will provide access to high quality, rapid, affordable diagnostic tests for care, treatment, prevention, and surveillance for HIV/AIDS.

Knowing the number of HIV/AIDS clinical laboratories can indicate if testing coverage is adequate or if more capable laboratories are needed.

Rationale

An important component for clinical care is laboratory services. In order to support PEPFAR programs, an adequate number of clinical laboratories are needed to perform testing for HIV/AIDS diagnostics, and care and treatment services. Determining the number of laboratories that can perform testing would measure the USG support to build laboratory capacity. This indicator will also serve as a proxy for measuring coverage of HIV/AIDS patient monitoring testing.

Numerator

Number of testing facilities (laboratories) with capacity to perform clinical laboratory tests

Denominator

None

Calculation

Not applicable

Method of measurement

A clinical laboratory is counted if the laboratory has the capacity (i.e. infrastructure, dedicated lab personnel, and equipment) to:

• Perform testing for the diagnosis of HIV infection with either rapid test, EIA or molecular methods; and,
• Perform clinical laboratory tests in any of the following areas: hematology, clinical chemistry, serology, microbiology, HIV/AIDS care and treatment monitoring with CD4 testing or HIV viral loads, TB diagnostic and identification, malaria infection diagnosis, and OI diagnosis.

A clinical laboratory can be a physical or mobile structure and must have dedicated laboratory personnel. A facility that does testing for only HIV rapid test diagnosis, such as a VCT or PMTCT site, should not be counted. If a facility is equipped to perform tests, but ran out of reagents or other necessary commodities at the time of reporting, it should still be counted.

The laboratory infrastructure will determine a laboratory’s capacity to do serology, hematology, microbiology, clinical chemistry, and CD4 testing. A tiered laboratory network is an integrated system of laboratories in alignment with the public health delivery network in a country.
In resource-limited settings, there are 3 to 4 levels of laboratories in the national network:
1. Primary health center lab,
2. Secondary district/regional lab,
3. Tertiary regional or provincial lab
4. National reference lab
All laboratories that meet the minimum definition of being capable of or actually performing HIV diagnostic *and* patient monitoring tests should be counted regardless of tiered capacity.

Many primary health centers and even some secondary district labs do not have the infrastructure or capacity to provide adequate laboratory testing for HIV/AIDS care and treatment services. In order to provide point-of-care services for HIV/AIDS patients at lower level public health facilities, laboratory infrastructure must be developed and strengthened. Monitoring the number of laboratories capable of providing HIV/AIDS diagnostic and patient monitoring testing seeks to evaluate USG-support to build laboratory capacity.

This indicator represents the sum of all PEPFAR-supported laboratories that perform HIV/AIDS related clinical laboratory testing for HIV diagnostics including rapid test, EIA, and molecular methods and have the capacity to perform patient monitoring testing for HIV/AIDS and/or for related infection diagnosis – these tests would include either CD4, hematology, clinical chemistry, HIV viral load, TB diagnostic and identification, malaria diagnosis, STI diagnosis, and OI diagnosis.

Measurement frequency

Continuously

Disaggregation

Age group:

Condom type: N/A

Education: N/A

Gender: N/A

Geographic location: N/A

HIV status: N/A

Pregnancy status: N/A

Sector: N/A

Service Type: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

Monitoring the number of laboratories capable of providing testing for PEPFAR programs seeks to evaluate USG-support to build laboratory capacity. This indicator, because of different capacities of laboratories, does not measure adequacy of coverage of laboratory services, but will give indication of trends in delivering laboratory services. It should be noted, laboratories at the higher level will have greater capacity for testing than those at a lower levels. This indicator also does not attempt to measure the quality, cost, and effectiveness of services provided.

Further information