existing challenges – poc introduction lab technical working group jason williams, principal...
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![Page 1: Existing Challenges – POC Introduction Lab Technical Working Group Jason Williams, Principal Laboratory Advisor, SCMS January 20-21, 2013](https://reader036.vdocuments.site/reader036/viewer/2022070412/56649ef05503460f94c01259/html5/thumbnails/1.jpg)
Existing Challenges – POC Introduction
Lab Technical Working Group
Jason Williams, Principal Laboratory Advisor, SCMS
January 20-21, 2013
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Overview
• Procurement perspective• Continuum of impact• Current CD4 situation• Existing POC challenges• Coordinated strategic response
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Procurement perspective
• Overarching challenges:• Limited stakeholder coordination and
communication regarding optimal use of diagnostic products
• Limited strategic and long term planning for the integration of new POC products coming to the market place
• Limited use of validated or accurate estimates of demand to inform deployment and work flow integration
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Continuum of impact
Har
mon
ized
Lab
Net
wor
k
Commodity Quantification
Instrument Coverage
Instrument Downtime
Forecast
Planning
Procurement
Distribution
Service Delivery
Point
Quality, Policy, & Guidelines Health System Strengthening Trends, Models & Regulation
Mar
ket D
ynam
ics
POC Integration
Emerging Technologies
Instrument validations
Global DonorsMinistry of Health
Health Service NetworkManufacturers
VendorsRegulatory Agencies
Supply Chain Optimization
Stakeholders
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PFSCM spend on laboratory commodities delivered through June 2012
$-
$5
$10
$15
$20
$25
$30
2007 2008 2009 2010 2011 2012
Mil
lio
ns
PfSCM Delivered Spend LOP thru June 2012
Flow Cytometry Biochemistry Hematology
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Optimization to reduce CD4 costs
• Optimizing laboratory procurement Selecting and procuring the right product within the national tiered laboratory system, with an appropriate throughput and complexity, that is sustainable within it’s regional and local setting.
• Strategy• Define the diagnostic coverage• Compare actual demand to capacity• Reduce instrument diversity• Increase utilization to reduce costs• Evidence based POC integration
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CD4: Finding the best cost / utilization
FACSCount versus FACSCalibur utilization price per test
Instrument Utilization Rate
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CD4 opportunities
• Greater efficiency may be established by maximizing CD4+ instrument utilization rates.
• Significant cost savings can be achieved by maximizing daily testing volumes per machine.
• Important to develop appropriate instrument placement strategies before procurement.
• Low-throughput point-of-care (POC) CD4+ testing platforms may contribute to lower costs per test.
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Existing POC Challenges
• Lengthy and unclear introduction/validation process
• Suboptimal instrument procurements and long term planning
• Optimizing existing lab infrastructure• Evidence based POC integration
• Long term impact not clearly understood• Instrument life span• Maintenance strategy development• Uptake – lessons learned
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Existing POC Challenges
• Limited government, donor, and technical coordination
• Competing priorities – treatment agenda (increased access) versus laboratory network development
• Vendor pressures (misleading)• Logistics (SDP not lab)
• Procurement, quantification, distribution, and maintenance
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Country X: PIMA POC example
• Program expansion driven by PMTC programs• No MOH laboratory involvement• Existing warranties have expired• Maintenance costs to be negotiated (currently at
$1,200/machine)
Overall 2012
Total number of sites 269
Sites with "0" consumption 46
Sites with consumption ≤ 1/day 91
% of sites with 0 or consuming ≤1/day 34%
% of sites with access to referral lab 30%
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Stakeholder relationships
REGULATORY
FDAWHOUSAID
CDC
OGAC
GF
UNITAID
SCMSUNICEF CHAI
PRs/VPP
ASLM ADVOCACY
Governments and Local Partners
TECHNICAL ASSISTANCE
PROCUREMENT
DONORS
MSF