Uganda looks to Point of Care innovations to roll-back HIV

By Esther Nakkazi 

HIV monitoring in treatment will be reduced from months to less than 70 minutes using new Point of Care Technology or POCT in a public-private partnership in Uganda. 

Point of care technology will also be used for Early Infant Diagnosis (EID) which will improve infants survival once they start early on HIV medication.

The m-PIMA™ HIV-1/2 VL by Abbott, a world leader in innovation and production of medical diagnostics, has been designed to provide healthcare professionals - especially in remote and underserved communities - with a fast, accurate, and easy-to-use test to help manage their patients' HIV.

"With a point of care diagnostic tools at our disposal in Uganda, there is great potential of reaching everybody in need and we are optimistic we shall achieve the targets (UNAIDS 90-90-90)," said Dr. Jane Aceng, the Minister for Health. 

She was speaking at the Laboratory diagnostic strategy towards eradication of HIV/AIDS, Tuberculosis and malaria in Uganda on the 16th August 2018 at Speke Resort Munyonyo. The optimism is premised on a new public-private partnership agreement which provides an opportunity for government and Abbott, to strengthen capacity implementation and support of POCT towards the achievement of the UNAIDS 90-90-90 by 2020 in Uganda.

"We are committed to supporting MoH in achieving the UNAIDS 90-90-90 goals for screening, care and monitoring and increasing access programmes for key populations and expanding access to areas like adolescents," said Damian Hallaron, Vice President Infectious Disease Emerging Markets at the conference.

He noted that in viral load monitoring, it's now a key element of the last 90 that undetectable means untransmittable (U=U). "Every patient on HIV monitoring deserves to know their status. So, we are working with global partners to secure funds to scale up our m-Pima capabilities. Imagine an m-Pima besides every Pima -the true standard for care for HIV monitoring in Uganda," Mr. Halloran said, adding that Abbott is committed to enhancing standard care in Uganda, to help people gain greater access to health services and ultimately save lives.

Abbott and the government of Uganda will provide the m-PIMA™ HIV-1/2 VL, the newest solution and the first viral load monitoring test at the point of care in health facilities. It has been evaluated in KCCA clinics with high volume sites in Kasangati, Kisenyi, Kiteebi, Kiswa, and Kawaala.

The m-PIMA™ HIV-1/2 VL is a portable, robust device and the m-PIMA platform can help address issues around infrastructure obstacles, shortage of skilled clinicians, logistical challenges and inefficient systems for providing results to patients. The m-PIMA HIV-1/2 VL test is now commercially available in select countries. Data has been submitted for CE-IVD marking and WHO prequalification.

Viral load testing is the gold standard for monitoring of individual treatment response, the effective use of costly antiretroviral medications, and to track the emergence of resistance in people who are HIV-positive. It has the potential to support the realisation of the UNAIDS 90-90-90 goals and end the AIDS epidemic by 2030. Experts said diagnostics are a vital component of a holistic effort to achieve the 90-90-90.

"It does not require ink and extra devices for it to work. You have the laboratory with you," said Joshua Buule, a medical laboratory scientists consultant in Kampala. 

"POCT is efficient as the tests are done there and then. It is the way to go because at the facility level there are many people who come to access care," said Dr. Simon Aliga, the District Health Officer, Amudat district. 

Dr. Aliga said with this technology long waiting lines at health facilities will be hard to see as there will be no sending patients to the laboratory and no congestion.

The World Health Organisation (WHO) recommends that all patients on antiretroviral therapy receive at least receive a viral load test at 6 months and 12 months, annually thereafter if the patient is stable on ART but very few patients receive that level of care. 

Scaling up of viral load testing is also a global priority, but countries face numerous challenges; limited infrastructure, shortage of skilled clinical and laboratory staff, weak specimen transport systems, insufficient systems for results feedback, lost samples lost results and patients lost to follow up. 

In 2015, Central Public Health Laboratories (CPHL) of the 10,113 patients eligible for a second viral load test, only 66 percent of patients with a detectable viral load received their results for the second test. 

Officials at CPHL said this informed them that the data is not utilised for patient management or some health facilities have no capacity to follow up patients.

"With POCT, samples will not be sent to the laboratory but the test system will be brought to the patient," said Mr. Halloran.

With POCT ART failure can be detected early, ART switching decisions can be made the same day, ART adherence problems can be addressed the same day, reduced sample transport costs, lost sample, lost results and patients will not be lost to follow up.

"In 70 minutes you have results - in less than an hour you can enroll an infant in care the first time you get in touch with it. You don't have to tell the client to go and come back another day," said Buule. "We want to go away from waiting - to a single test and a bedside test point of care."

"This is particularly important and timely when co-infection between HIV, Hepatitis, and TB is at its peak. Ministry of Health entered an agreement with Abbott the leading manufacturer of OCT devices in the world," said Dr. Aceng.

Dr. Aliga said the challenge with POCT is the human resource. "There is no district with a 100 percent human resource."