Slow monitoring and testing procedures hamper ARV access

Access to antiretroviral (ARV) treatment in South Africa's KwaZulu-Natal province is being hampered by long delays in tests required for HIV/AIDS monitoring. Some of the province's hospitals and clinics wait up to six weeks to receive laboratory results for the CD4 count tests of patients (which measure the strength of the immune system), healthcare workers said. Results for such tests should ideally be available in a few days' time. Existing international guidelines for managing patients on antiretroviral therapy (ART) use viral load and CD4 count testing to measure the impact of ART on the patient's health. In South Africa, HIV-positive people with a CD4 count of less than 200 are eligible for free ARV treatment through the public health system. When people living with AIDS have reached an advanced stage of the disease, quick access to the life-prolonging drugs is crucial. In some cases, several weeks' waiting time for test results can mean life or death. Delays have been attributed to staff shortages, lack of equipment and an inefficient courier system for transporting blood samples and test results between hospitals and laboratories. The equipment for measuring CD4 counts is expensive, with the added cost of hiring and training technical staff, maintaining and repairing broken equipment and shipping and storing samples. An estimated 55,000 CD4 count tests are performed each month in South Africa, which has 25 laboratories capable of conducting CD4 counts, and only 10 laboratories for testing HIV-positive viral loads. In KwaZulu-Natal (KZN), only seven of the 11 health districts have a laboratory equipped to conduct CD4 testing; consequently, a large number of hospitals and clinics, particularly those in rural areas, have to send blood samples long distances to the nearest specialised laboratory. Although the KZN health department plans to set up adequate monitoring infrastructure in all 11 districts, this would still be insufficient to handle the province's demand for testing, commented Alan Smith, head of the virology department at Albert Luthuli Hospital in Durban, who also oversees all the provincial virology laboratories in KZN. The expansion of laboratory services was also limited by a lack of human resource capacity. Smith noted that skilled personnel were hard to find, as "qualified staff prefer [to work in] the private sector", where they earned higher salaries. At the Albert Luthuli hospital's laboratory, for example, staff were "overworked", and viral load testing already had a backlog of three weeks, he added. Smith warned that CD4 count testing had to be carried out more quickly, as the cells being tested had a maximum lifespan of five days. South Africa plans to open 18 additional laboratories for performing CD4 counts and eight laboratories offering viral load testing before the end of this year. Nevertheless, the government's current courier system was "not efficient", Smith said, explaining that "Since it depends on CD4 count tests if a patient can enrol in the [governmental] ARV programme, long delays in getting results will postpone a patient's access to treatment." Health experts have attributed these challenges to the KZN tender being awarded to companies that did not have the capacity to deliver the level of service required. The appointed firms have subsequently subcontracted to other transport agencies, making it difficult to manage the delivery system. The delays in delivering test results have prompted some hospitals, such as the Church of Scotland Hospital in Tugela Ferry in KZN, to hire a private courier service to transport blood samples to and from the laboratory. According to Dr Tony Moll, head of the hospital's AIDS Clinic, this enabled the facility to get results for almost all its specimens in about two weeks' time, without having to rely on the "terribly slow" state transport service, which had a turnaround time of between five and six weeks in rural areas. Employing a private courier service, however, was costly, and the AIDS Clinic had received donor funding to finance the service.