Delayed test results often mean HIV patients in Mozambique fail to get timely treatment, but new technology is reducing the need to send tests to far away laboratories, and speeding up test results and HIV treatment.
Mozambique’s Ministry of Health has increasingly begun experimenting with new technology to make diagnosing and monitoring HIV patients quicker and easier. After a successful 2009 pilot the country has nationally rolled out SMS or text message printers, which transmit the results of infant HIV tests electronically from two central reference laboratories in Maputo and the northern provincial capital, Nampula, to more than 275 health centres.
Previously test samples and results would have taken on average three weeks, and up to several months to be transported to and from clinics via car, plane and even kayak in remote parts of the country.
According to research conducted by the Ministry of Health and the Clinton Health Access Initiative (CHAI), who developed the technology, the time it took for clinics to receive test results from reference labs dropped from an average of about three weeks to about three days after the printers were introduced. Research presented by the Ministry of Health and CHAI at the International AIDS Conference 2010 in Vienna, Austria, showed that this, in turn, reduced the time it took to start infants on antiretroviral (ARV) treatment as part of national prevention of mother-to-child (PMTCT) HIV transmission services by about four months. The number of infants starting treatment also increased by 60 percent.
How the technology works: Clinics collect dried blood spot samples from infants and transport them to the nearest reference lab, where technicians conduct the HIV tests. Results are entered into a database and uploaded onto an online server, which then uses a wireless phone network to transmit results back to clinics. These clinics receive a small, receipt-like print out of the results alongside a patient identification number.
With interruptions in electricity and wireless network signal, the system has an added failsafe - if printers are offline, results are safeguarded in an online queue until the printer is available. The printer's small size also makes storage easy in space-constrained clinics, which must also ensure that the printer is kept in a secure room to guarantee patient confidentiality.
Clinic-based, or point-of-care (PoC), CD4 count machines - vital to measuring an individual's readiness to start antiretroviral treatment - will also be rolled out to selected clinics by the end of November 2010, following positive results from a seven-site trial.
The introduction of a SMS printer to a Matola city clinic, about 30 minutes outside Maputo, has not only meant that babies who test HIV-positive can be started on ARVs sooner - a potentially life-saving intervention - but also reduced the numbers of new mums who disappear from the clinic’s PMTCT programme during the long wait times or after having spent time and money on multiple clinic visits to check for results.
According to Mozambique’s 2010 report to the UN General Assembly Special Session on HIV/AIDS (UNGASS), about 30 percent of babies born to HIV-positive mothers contract the virus, but only about 14 percent of these babies are tested for HIV before the age of 18 months. Without treatment one-third of HIV-positive babies will die in their first year of life, and almost half by the age of two, the UN Children's Fund (UNICEF) says.
|There’s increasing talk about this type of technology’s use in TB...there’s a revolution that is going to happen and we need to be ready for it|
The clinic in Matola was also one of initial sites to pilot the PoC CD4 count machine. Smaller than a cash register, it has decreased the wait time for a CD4 count from one week to about 20 minutes, according to lab technician Gerardo Cumbane, who received one day of training on how to operate the new equipment.
As many doctors are hesitant to start patients on ARVs without evidence that their CD4 counts have dropped below 250 - the threshold for treatment initiation in Mozambique - the faster results mean quicker access to the life-prolonging drugs.
Currently, the CD4 count machines cost about US$5,000 each.
Ilesh Jani, head of the Department of Immunology at the Mozambican National Institute of Health, has led the push for new technology within the health system, along with a young team at the department. While he said that the same technology used by the CD4 count machines may be used to diagnose other disease like malaria in the future, he cautioned that many new technologies are not “plug and play”.
The way the new technology changes patient flows and health workers’ case loads can have significant ripple effects, impacting everything from the way clinics are built to the demand for drugs.
Jani said that other developing countries wanting to introduce new or PoC technology will need to consider everything from the size of waiting rooms to equipment durability.
“Most technologies that we work with are created in the Western world and sometimes the people designing [them] don’t really know ‘the field,’” he told IRIN/PlusNews. “There’s a lot of dialogue that has to happen between us and the people who produce the technology.”
In the case of Mozambique, the Ministry of Health and its implementing partners learned some interesting lessons along the way. For instance, the lancets originally used to collect blood for use in the CD4 count machines had to be substituted for lancets that could more easily draw blood from the calloused hands of many rural Mozambican patients. Similarly, technicians had to adapt the way they drew blood as well.
In rural areas with poor mobile phone uptake, technicians also needed more training to feel comfortable with the cell phone-like keypad of the CD4 machines. And implementing partners also found that printers in dry, dusty areas need more regular maintenance than initially thought.
The country also found that the introduction of new technology drove up the demand for drugs at some facilities that were initiating more patients, more quickly. As a result, the entire drug supply chain had to be examined to ensure it could cope.
After feeding back some of this information to product developers, who improved product design, the Ministry of Health is also working on establishing criteria to evaluate emerging technology, Jani told IRIN/PlusNews.
“In the field of HIV, we’ll most likely be seeing instruments for viral load testing; there’s increasing talk about this type of technology’s use in TB,” he said. “There’s a revolution that is going to happen and we need to be ready for it.”