Public-private sector partnerships: Contracting with private sector laboratories in Botswana to close viral load testing gaps during COVID-19 and beyond

BACKGROUND: Challenges around viral load (VL) testing include equipment breakdowns, reagents stock-outs, shortages of trained staff, and long turnaround times (TAT) for results. These challenges prevent timely decision-making around client care. In Botswana, routine public sector VL testing was drastically affected at the national level by COVID-19 response measures, exacerbating existing challenges. The USAID/PEPFAR-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project piloted VL testing through private laboratories.
DESCRIPTION: EpiC contracted with a private laboratory to conduct VL testing at US$20 per test'comparable to public laboratory testing but less than half the usual cost in private laboratories. From October 2020 to September 2021, health providers in 12 clinics across 10 districts in Botswana collected VL samples at the health facilities or referred clients to their choice of one of the nation's 25 private lab-operated depots for VL sample collection, which clients could schedule at convenient times, including weekends. The private laboratory transported and processed samples, then returned the results to the referring provider through a secure electronic portal within 24 hours
LESSONS LEARNED: VL testing through private laboratories offered clients more location and scheduling options for sample collection, improving VL testing coverage among key population (KP) individuals who may not have received a VL test otherwise due to challenges in accessing services. From October 2020 to September 2021, 5,123 VL tests were conducted via private laboratories, 20% of which (1,042) were from KPs. At the 12 participating clinics, VL testing coverage increased significantly from 83% to 90% for KPs and slightly among the general population (90% to 91%). In addition, the TAT of results decreased from one to six weeks before the intervention to 24 hours following the intervention.
CONCLUSIONS: VL testing through private laboratories was feasible in Botswana at costs similar to public laboratory testing in the country. Countries with strong private laboratory systems should consider private-public partnerships to increase national VL testing capacity during COVID-19 and beyond. This model could help close VL testing gaps for KPs and other groups who face challenges in accessing HIV services.

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