id	author	title	date	pages	extension	mime	words	sentence	flesch	summary	cache	txt
ajlm-545	Cassim, Naseem; Smith, Honora; Coetzee, Lindi M.; Glencross, Deborah K.	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	2017		.htm	text/html	4180	173	44	CD4 laboratories would increase to 41 in scenario B and 61 in scenario C. POC testing would be offered at two sites in scenario B and 20 sites in scenario C. 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 ITSDM model aims to ensure efficient, cost-effective provision of quality testing across all health districts.1 This ‘full coverage’ model strives toward equitable access to CD4 testing by providing technology that appropriately matches service delivery requirements, based on factors such as test volumes, distances from referring clinics to CD4 laboratories, and the package of clinical services offered by health facilities.1 Five testing tiers, along with a sixth coordinating tier, are defined in the ITSDM model: (1) true point-of-care (POC) services (Tier 1), reserved for hard-to-reach areas, where nursing staff attending to patients operate the testing system (< 3 tests per system per day) and initiate patients onto antiretroviral therapy; (2) POC hubs (Tier 2), namely, ‘mini-laboratories’ using only POC equipment for all relevant HIV and tuberculosis tests at a rate of < 10 samples per day in rural health districts; (3) community laboratories (Tier 3) processing less than 100 samples per day; (4) district laboratories (Tier 4) processing between 100 and 299 samples per day; (5) high volume centralised laboratories (Tier 5) processing in excess of 300 samples per day; and (6) Tier 6, representing a national reference/‘monitoring and evaluation’ centre responsible for coordination, harmonisation and standardisation of testing, as well as coordination of training and quality control across a national network of laboratories and related testing sites.1 It would also be cost effective to consolidate Tier 4 and/or Tier 5 laboratories into larger centralised laboratories (‘super-laboratory’/Tier 6 level) that could process in excess of 600 samples per day, depending on efficiency of local transport systems.1 This would, however, create coverage gaps that would need to be addressed with POC in remote ‘hard to reach’ areas.1 An analysis of test volumes identified that the majority of CD4 samples were received from primary healthcare clinics (67%), with a further 8% from larger community healthcare centres; this tells us that hospitals only account for 25% of test volumes.1 This confirms the decentralisation of CD4 test requests.	cache/ajlm-545.htm	txt/ajlm-545.txt