Racing for results: lessons learnt in improving the efficiency of HIV viral load and early infant diagnosis result delivery from laboratory to clinic.

INTRODUCTION: In pursuit of the 90-90-90 goals, emphasis has been placed on accelerating centralized-laboratory HIV viral load testing of a population that is largely rural and decentralized. Successful outcome requires effective specimen transport, laboratory testing, and results delivery. This paper focuses on the methods currently employed for results delivery. New innovations in this area are yielding mixed results; we analyze different approaches and estimate the impact of each on achieving the third '90.' Areas covered: Strategies employing electronic or mobile health platforms, such as online portals, SMS, and SMS printers are showing potential to deliver results in significantly improved turnaround times but are not without challenges. Also, merely delivering a result to the clinic is not sufficient; results need to be actioned to ensure improved patient linkage and retention. Innovative solutions that not only support real-time reporting but monitor receipt of results and address infrastructure constraints faced by limited-resource settings are discussed. Expert commentary: There is tremendous opportunity to inform better patient care and directly contribute to '90-90-90' progress by developing digital systems for result delivery. Besides infrastructure and technical challenges, systems should address the entire cascade of care from initial diagnosis to monitoring treatment response.

How do we get the medical intelligence out?

Two factors are driving a new wave of medical products. The first is the use of technology to make products "intelligent"--that is, build them not only to measure a particular parameter, like blood glucose, but to help patients and caregivers manage conditions. This allows the users of these products focus less on the technical aspects of treating a condition (e.g. calculating the proper amount of insulin to treat a given level of blood glucose) and more on the overall management of the disease. The second development is the rapid movement of devices from the doctor's office to the home. Chain drug stores carry dozens of medical devices for home use by consumers. The challenge for manufacturers and designers is to present the medical device's intelligence in a way that is palatable to the consumer. One important theme is that medical product consumers are also consumers of everything else: home electronics, appliances, clothing, etc. These consumers are applying the same decision-making processes they use when buying a blender to the process of buying a medical device. It is therefore necessary for medical product manufacturers to create devices that interact with consumers in consumer-friendly ways. Putting intelligence into a product is one thing; helping the consumer utilize and appreciate it is quite another. This chapter covers some principles to keep in mind, and discusses a framework for better design of intelligent medical products that connect with consumers on emotional and functional levels beyond simple medical efficacy.