Optimal Decentralization of Early Infant Diagnosis of HIV in Resource-Limited Settings

Deo, S and Sohoni, M G (2014) Optimal Decentralization of Early Infant Diagnosis of HIV in Resource-Limited Settings. Working Paper. Indian School of Business, Hyderabad. (Unpublished)

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Early infant diagnosis (EID) programs in many resource-limited settings are aimed at diagnosing infants
born to HIV positive mothers. Due to the complexity of the diagnostic technology, EID programs are often
highly centralized with few laboratories testing blood samples from a large network of health facilities. This
leads to long diagnostic delays and consequent failure of patients to collect results in a timely manner. Several
point-of-care (POC) devices that provide rapid diagnosis within the health facilities are being developed to
mitigate these drawbacks of centralized EID networks. We study the decision of which facilities should receive
the POC device (the placement plan) using the EID program in Mozambique as a case-study. We argue that
the choice of an appropriate plan is critical to maximizing the public health impact of POC devices in the
presence of tight budget constraints. To formalize this argument, we develop a detailed simulation model to
evaluate the impact of a placement plan. It comprises two parts: an operational model that quantifies the
impact of a POC placement plan on the diagnostic delay and a behavioral part that quantifies the impact of
diagnostic delay on the likelihood of result collection by infants’ caregivers. We also develop an approximate
version of these operational and patient behavior dynamics and embed them in an optimization model to
generate candidate POC placement plans. We find that the optimization based plan can result in up to 30%
more patients collecting their results compared to rules of thumb that have practical appeal. Finally, we
show that the effectiveness of POC devices is much higher than other operational improvements to the EID
network such as increased laboratory capacity, reduced transportation delay, and more regularized transport

Affiliation: Indian School of Business
ISB Creiators:
ISB Creators
Deo, S
Sohoni, M G
Item Type: Monograph (Working Paper)
Subjects: Health care and delivery
Depositing User: LRC ISB
Date Deposited: 21 Oct 2014 08:02
Last Modified: 17 Jun 2015 07:50
URI: http://eprints.exchange.isb.edu/id/eprint/10
Publisher URL: http://www.isb.edu
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