POC Site Selection

To ensure that appropriate sites are selected for POC testing, a robust site-selection process is required among government and stakeholders. A process that effectively maps and prioritizes health facilities for adoption of new POC technologies is required to ensure maximum impact on the greatest number of patients. See appendix 3 for details of roles and responsibilities of
key stakeholders.

Process for conducting site selection:

A leadership team from MOPH in collaboration with partners will conduct a mapping exercise of all health facilities with active ART/PMTCT/VCT sites. This mapping exercise will consider the different POC technologies best suited for the various health facility types and/or patient numbers. Private clinics should be included as part of this mapping exercise if they are considered as ART/PMTCT/VCT sites and have an arrangement with the MOH. The team will identify sites that qualify for the POC technology that is being introduced using the site selection criteria (below) and will prioritize sites. The team will allocate the POC devices or technologies available and produce the site selection list. POC testing is not ideal for every site, and is not meant to replace conventional testing or the existing laboratory infrastructure. It is important to recognize that different POCT devices will be optimal for different settings, and therefore clear site selection criteria are needed. Maximizing patient impact should be the guiding principle for introduction and site deployment of these devices. As such, the following pre-defined site characteristics

Site Selection Criteria

Facilities that do not have conventional diagnostic technologies on-site will be prioritized to receive POC technologies. Other key factors that will drive prioritization:
a) Patient volume (actual or expected): Patient need and demand will be measured for each facility based on the number of patients requiring POC testing, or number of patients enrolled in pre-ART and ART care. Non-ART sites may also be considered for placement of technologies.
b) Current access to testing: Introducing a POC technology will have more impact at a facility with no access to testing than at one with strong access to testing through sample referral; therefore, accessibility of and distance to conventional CD4 testing should impact prioritization. High-burden facilities with a conventional diagnostic may be considered to receive a POC technology at a particular entry point, for example in the ANC or VCT. POC technologies are not recommended for use as back-up devices for conventional machines.
This would add unnecessary complications, as it would require creating a back-up supply chain system and training additional operators. Additionally, POC technologies rarely have similar through puts and therefore would not fulfill the testing volumes of conventional machines. Instead, sample referral networks and improved service and maintenance should be the solutions if conventional devices break down.