CfHSS team with the Regional Health Director, Dr. Godfred Kwabena Sarpong

The Western North Region (WNR) has 6 of its 9 districts equipped with the GeneXpert MTB/RIF analyzer (Figure 1). Previously used for TB testing, the analyzers have been assessed and validated for use for HIV viral load (VL) and early infant diagnosis (EID) testing. CfHSS previously engaged the regional Medical Laboratory Scientist and Sample Referral System (SRS) focal person to understand the general outline of the SRS in the region in an introductory meeting in May 2024. As part of this engagement, key interventions aimed at supporting the region’s HIV VL and EID testing were agreed on. As a result, CfHSS undertook a two monitoring and supportive supervision exercises to all the testing sites (hubs) and selected ART sites (spokes) linked to the testing sites.

The purpose of the first monitoring and supportive supervision exercise was to objectively (1) gather first-hand information on the working modalities of the SRS at the various facilities, (2) assess their documentations and protocols for HIV VL and EID testing and (3) offer supportive and technical assistance to improve the SRS at these facilities.

The second monitoring exercise was conducted to (1) extract the turnaround times from the sample tracking log books distributed during the initial monitoring exercise, (2) review the previously modified lab documents and new ones advised to be developed, including corrective action log books and non-conformance log books (3) monitor the implementation of the data integrity training previously undertaken and (4) monitor the overall SRS in the region.

Project Sites

The pilot project was conducted in the Western North Region of Ghana, using the ‘Hubs and Spokes’ model. The region has 24 ART sites, comprising 6 testing sites (hub) and 18 sample mobilization sites (spoke) (Appendix 1).

Project Duration

The period of this sample referral system programme was from April to June 2024.
However, active implementation at the healthcare facility level was conducted from last week in May to 28th June, 2024. Prior to the piloting phase, several consultative meetings and monitoring exercises were carried out in the region.

First Monitoring

The first monitoring exercise was carried out on 20 – 24 May, 2024. Of the 24 ART sites in the region, 18 were visited, which includes 12 spokes and all the 6 Hubs.

Purpose of first monitoring exercise

The purpose of this monitoring and supportive supervision exercise was to:

(1) gather first-hand information on the working modalities of the SRS at the various facilities,

(2) assess their documentations and protocols for HIV VL and EID testing and

(3) offer supportive and technical assistance to improve the SRS at these facilities.

Key activities of first monitoring exercise

Data tracking tools, distance logbooks, laboratory sample reception log books and results reporting log books were disseminated for collecting and tracking data. A total of 19 tracking logbooks were distributed. In addition, good documentation practices (Data Integrity) training was conducted for all 18 facilities visited, to ensure accuracy, consistency and reliability in data collection and records keeping.

Key Observations from first monitoring

• All facilities had protocols for sample collection, processing, packaging and transportation.
• Each referring facility had a designated personnel for sample transportation to testing sites.
• All the testing sites had their GeneXpert analyzers serviced frequently and maintained.
• Averagely, there was a considerable reduction in results TAT since the use of GeneXpert for HIV viral load and EID testing, from 2-3 months on average to 24hrs at most, with results reaching the clinician in a week.

Second Monitoring

The second monitoring exercise took place on 24 – 27 June, 2024. All the six hubs were visited during this exercise, as they were responsible for completing the data tracking log books.

Purpose of Second monitoring exercise

The purpose of this monitoring and supportive supervision exercise was to:

(1) extract the turnaround times from the sample tracking log books distributed during the initial monitoring exercise,

(2) review the previously modified lab documents and new ones advised to be developed, including corrective action log books and non-conformance log books

(3) monitor the implementation of the data integrity training previously undertaken and

(4) monitor the overall SRS in the region.

Key activities of second monitoring exercise

• Extraction of the turnaround time (TAT) from the tracking log books distributed during the 1st monitoring event.

• Sample transportation distance TAT (from spoke to hub)

• Review various lab documents previously modified and new ones that were advised to be developed including corrective action log books and non-conformances log books.

• Review data that has been collected so far and any challenges regarding their inception.

• Monitor the implementation of the data integrity training previously conducted.
• Monitor over all SRS in the region

• Gather performance indicators with the regional SRS coordinator from the various hubs.
• Compare the data already pooled from each facility for consistency and accuracy.

Key Observations from second monitoring

• All facilities showed improvement in documentation practices. Each facility had updated all necessary documents, and non-conformance documents have been developed and are already in use.
• Data collected so far are consistent and accurate.

Accomplishments

The following were achieved:

• Dissemination of tracking tools
• Non-conformance and corrective action log books were developed and in use
• Training on good documentation practices
• Weekly collection of performance indicators
• Extraction of turnaround time
• Comparison of data for consistency and accuracy
• Distribution of stationary

Table 1. Testing facilities (hubs) and corresponding referral facilities (spokes)

Images from Monitoring

CfHSS team with the Regional Health Director, Dr. Godfred Kwabena Sarpong

Meeting with the laboratory personnel of each hub for assessment of their GeneXpert analyzers (left) and with regional Biomedical scientist/focal person SRS (Right)

CfHSS team engaging the various ART facilities