FACTORS AFFECTING QUALITY OF LABORATORY SERVICES AT INFECTIOUS DISEASES HOSPITAL
Quality laboratory services are essential and integral part of improved health outcome especially for HIV/AIDS patients on ART. We aimed to assess clients‘ satisfaction with laboratory services as an indicator of quality and factors affecting quality of laboratory services from service providers‘ perspective. We conducted a hospital based cross-sectional study from January-April 2014 among adult HIV/AIDS patients attending IDH Kano, Nigeria. An exit and service providers‘ questionnaires were administered to clients and laboratory service providers respectively. We used SLIPTA laboratory inventory checklist to assess the availability of equipment, reagents, consumables and test profiles for patients on ART. A total of 212 HIV positive patients attending laboratory for ART monitoring tests at IDH participated in the study. Of these, 65.6% were females. The mean (±SD) age, of the participants was 36.7 ± 10.2 and 36.3% were in the age group (30-39), 58% were married, 10% were single, while 6% and 26% were divorced and widowed respectively. Majority of the clients (70%) were on antiretroviral therapy (ART). The overall level of satisfaction with laboratory services calculated from a single indicator variable was 97.6%. Internal quality control (IQC) is conducted always for chemistry, and CD4 counts as stated by more than 90% of the respondents (records seen) while IQC for haematological indices is done only occasionally due to stock out of control reagents. The equipments used for HIV/AIDS monitoring tests for CD4 count, haematology and chemistry were available and functional but more than 50% were in use for more than 5 years. Repairs and service maintenance are done on site through service contract signed by donor organizations. In conclusion, the satisfaction level of the clients on laboratory services received was high, which suggested acceptable quality of services offered. Form of visit to HF (follow-up visit), and ―waiting time‖ before clients are attended by service providers, were found to be the factors associated with client satisfaction. Inadequate work force was identified as one of the major factors affecting quality of laboratory services by 80% of service providers, inadequate training of laboratory personnel (72%), lack of EQA and IQC on some tests (45%), interrupted power supply that led to frequent equipment breakdown (86%) and infrastructural inadequacy (space) to accommodate all the equipment, staff, as well as the patients (64%). The clients identified stigma, location of the laboratory distant from the ART clinic and lack of awareness on the xiv importance of the laboratory tests in the management of the patient as barriers to accessing laboratory services.
1.1 Background Information
Medical laboratory services are essential in the diagnosis and assessment of the health of patients. Their services encompass arrangements for requisition, patient preparation and patient identification, collection of samples, transportation, storage, processing and examination of clinical samples, together with subsequent result validation, interpretation, reporting and advice. For people suffering from HIV/AIDS, these services are critical for initial placement of patients on antiretrovirals (ART) and continuous monitoring of disease progression over a period. In the West African region, laboratory services are the most neglected components within the health systems especially regarding HIV/AIDS treatment and monitoring. Lack of access to necessary quality diagnostic tests in support of HIV/AIDs treatment and monitoring such as CD4 cell counts, viral load, complete blood count (CBC), chemistry tests, has significantly affected the provision of drug therapy for more than two decades from the emergence of HIV/AIDs in the region.5 This factor alone, served as a catalyst to increased morbidity with increased burden on global public health. 4 In Nigeria, prior to considerable efforts devoted to strengthening laboratory systems under Global HIV/AIDS Initiative, provision of clinical laboratory services was a major issue. All laboratories in hospitals offering ART services faced major challenges including poor infrastructure, inadequately trained personnel and lack of standardized operating procedures that could potentially compromise quality of services to patients.