Technology Revolution Hits HIV Testing and Treatment
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 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 an 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.
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.