The Sunday News
Tinomuda Chakanyuka and Mirirai Nsingo, Feature Reporters
THIRTY-FIVE-YEAR-OLD Ms Vimbai Maphosa from Mataga in Mberengwa District has just delivered a bouncing baby boy.
She had only gotten to know of her HIV positive status during antenatal care at her local clinic. Her only prayer is that her new bundle of joy was not infected by the virus during birth. She aptly named the baby Hope.
Having gone through the Prevention from Mother to Child Transmission (PMCTC) programme, Vimbai has a flicker of hope that her baby could be “clean”. But she wants to be certain as soon as possible, yet she is told to go home and come back after six weeks for the baby to be tested for HIV.
The six weeks would seem like an eternity for Vimbai, as anxiety gets the better of her. She will have to wait much longer and contend with the apprehension a little more. After six weeks, with Hope strapped onto her back, Vimbai trudges 15km of flatland and valley to the clinic, to have her child tested for HIV.
Dry Blood Spot (DBS) specimen is taken from Hope and the health care worker tells Vimbai to go back home again and come back to the health centre after about eight weeks for the results. She sighs in dejection, as the waiting further prolongs amid intense anxiety, the worst Vimbai has experienced.
Because of the centralised laboratory HIV diagnostic system, Hope’s blood samples have to be sent to Mberengwa District Hospital. Apparently samples from the local clinic are only sent to the district hospital once a week and on the day Vimbai visited the healthcare centre the batch for that week had already been sent.
Hope’s blood samples have to stay another week at the local clinic before being conveyed to the district hospital. From the district hospital where the samples are likely to stay yet another week, the specimen are further conveyed to Mpilo Central Hospital laboratory in Bulawayo for examination. The laboratory at Mpilo Central Hospital caters for Bulawayo, Matabeleland North, Matabeleland South and Midlands provinces and is thus overwhelmed.
It takes the laboratory a minimum of 10 days to complete examination of the blood samples and produce results. When the results are out, they would be sent back to Vimbai via the same chain from Mpilo Central Hospital, to Mberengwa District Hospital and finally the local clinic.
This process will take another two weeks and all this while Vimbai will be waiting with her concerns growing as every second ticks. If Vimbai’s baby tests HIV positive, clinical intervention would have been delayed by almost two months, increasing chances of losing Hope to the virus.
Vimbai’s dilemma mirrors that of several other HIV positive mothers around the country, who have had to wait for long periods before knowing the status of their children. The centralised laboratory HIV diagnostic system has been making paediatric HIV management a nightmare, not only for mothers but for health workers too.
Available data shows that 50 percent of infants infected with HIV die before two years of age unless they receive medical treatment. However, with the new frontiers in science and technology that are being explored in the management of HIV, stories like Vimbai’s are fast becoming history.
The introduction of Point of Care in HIV management, particularly in children is expected to accelerate the fight against the virus towards ending Aids by 2020. Point of Care refers to the provision of prompt diagnosis and rapid treatment at a health facility over the shortest possible period during a single visit by a patient.
The Ministry of Health and Child Care has just acquired 100 HIV point of care (POC) machines worth over $5 million which will be distributed across all the country’s 10 provinces.
This will see robust decentralisation of integrated HIV services to low level clinics to increase access of the services, while reducing the turnaround time of the services from several weeks to a single day.
Head of the Aids and TB Unit in the Ministry of Health and Child Care Dr Owen Mugurungi said the new technology will be used primarily for Early Infant Diagnosis (EID).
The SAMBA point of care machines, which the Government acquired from a UK based company, Diagnostics for the Real World (DRW), can also carry out viral load tests.
Dr Mugurungi said by reducing the turnaround time between diagnosis and clinical intervention, Point of Care technology will help curb loss of infant lives to HIV.
“The objective of introducing Point of Care is to reduce the turnaround time between a test and getting the result and putting that person onto treatment. The second bit is to reinforce the decentralisation that we aspire, that treatment happens as close to the patient as possible and of course the overall goal is to reach our 90-90-90 targets,” he said.
Dr Mugurungi said the 100 machines will be distributed equitably across the country’s 10 provinces targeting health care facilities with high volumes of child births.
“Ideally these machines have been identified for the Early Infant Diagnosis (EID) programme where we have prioritised the issue of knowing the status of those exposed babies or babies that are born of HIV positive mothers. We want to know that if a woman is HIV positive and delivers a baby, within the period of the three days when they are at the clinic before they go home, we need to know if there was any transmission of the virus to the baby. If there was transmission, then the baby would be put on treatment immediately,” he said.
Dr Mugurungi said the Government was also looking at expansively rolling out of Point of Care technology across the country to accelerate the country’s drive to achieve the 90-90-90 targets to end Aids by 2030. A Point of Care pilot was carried out at two city health clinics in Harare using SAMBA machines. Principal Laboratory Scientist in the Ministry of Health and Child Care Mrs Sandra Chipuka who oversaw the pilot, described the outcomes of the pilot as impressive.
“The main objective was to see the average turnaround time and time to clinical intervention. We also wanted to evaluate loss to follow up and the ease of use of these machines. The turnaround time using Point of Care was around two hours. Patient could be tested, get their results and be put on treatment on the same day. The time to clinical intervention was reduced drastically,” she said.
Mrs Chipuka said as opposed to the centralised system which requires huge machines operated by laboratory scientists, Point of Care machines were easy to use and can actually be used by health care workers at low level clinics.
“You can train carders at health care centres to use the machines and still achieve optimum results. The machines are quite user friendly, portable with a back-up battery in case of power outages. They’re quite suitable for rural settings,” she said.
Dr Hellen Lee, the president and chief executive officer of DRW Biotech, manufacturers of SAMBA point of care machines, said point of care technology was the ideal tool to accelerate countries’ drives towards the 90-90-90 objectives.
She said the technology was ideal for developing countries where most people stay in rural areas where access to integrated HIV services is limited, largely constrained by poor road networks.
“This is the tool of the moment in HIV management. This is the tool which allows us to go to the rural areas which can’t be adequately serviced by the centralised system,” she said.
Added Dr Lee, “with infectious diseases’ rapidity of tests and results is critical. Infection need to be recognised before virus or bacteria multiplies. The sooner you stop it the better.”
The SAMBA Point of Care technology which was on show at the just ended International Conference on Aids and STIs in Abidjan, Cote d’Ivoire uses nucleic acid amplification to detect the HIV virus in blood samples and is as accurate as the high through-put laboratory machines. Apart from HIV testing the machines, which are the size of a coffee machine can also be used to detect Hepatitis B, C, flue and STI infections.
