Impact of organizational factors on adherence to laboratory testing protocols in adult HIV care in Lusaka, Zambia (BMC Health Services Research)

Background: Previous operational research studies have demonstrated the feasibility of large-scale publicsector ART programs in resource-limited settings. However, organizational and structuraldeterminants of quality of care have not been studied. Methods: Using data on 13 urban HIV treatment facilities in Zambia, we use multivariate regressionmodels to assess the impact of structural determinants on health workers` adherence tonational guidelines for conducting laboratory tests such as CD4, hemoglobin and liverfunction and WHO staging during initial and follow-up visits as part of Zambian HIV careand treatment program. Results: CD4 tests were more routinely ordered during initial history and physical (IHP) than followup(FUP) visits (85.5 % vs. 93.0 %; p < 0.01). More physical space, higher staff turnover andgreater facility experience with ART was associated with greater odds of conducting tests.Higher staff experience decreased the odds of conducting CD4 tests in FUP (OR 0.93; p