Ed note. I’m posting from Liberia this week where I am accompanying a delegation from UNITAID that is visiting health projects in the country.
(Monrovia, Liberia) –Pretty much anywhere in the world, when a person tests positive for HIV, the next step is to get your white blood cells counted. When the “CD-4” count, as it is known, falls below a certain threshold that person is prescribed anti-retroviral treatment (ARTs). HIV positive people are generally not put on ARTs right away because once treatment starts, it must continue for life.
It is a relatively straightforward process… provided that lab technicians have a CD-4 counter. Here in Liberia, that’s where the problem lies.
I visited the Redemption hospital in Monrovia, the largest treatment center HIV patients in the country. They have plenty of ARTs available, but no working diagnostic tools. Their one CD-4 counter is in disrepair. That leaves doctors and nurses forced to use less than state-of-the art techniques to deduce whether or not a patients’ HIV has progressed to the point at which they need to start ARTs. One official described this to me as “guesswork.”
But at least there are a few CD-4 counters in the country, even if they don’t work. That is more than can be said of a viral load counter. You see, testing an HIV positive patient’s viral load is very standard. If the viral load goes too high, it generally means that the treatment regimen is not working and that a different kind of ART should be used. There is no such diagnostic machine in this country. Care providers are forced to make an educated guess based on a patient’s symptoms.
The same is true with infants born from HIV positive mothers. A special diagnostic tool called a PCR Machine is used to test whether or not a mother has transmitted HIV to her baby. Needless to say, there are no PCR Machines in Liberia. At the Redemption Hospital, doctors send samples to South Africa then wait four to six weeks for the result.
On the one hand, you might expect a country emerging from civil war to lack more advanced diagnostic tools like a viral load test or PCR machine. But the lack of a basic CD4 counter is particularly egregious.
Enter UNITAID. In the next several months, UNITAID will sharply reduce the cost of diagnostic tools like the CD-4 counter. Not only that, but UNITAID is creating a market for the manufacture of specialized counters that don’t depend on a steady electricity supply. This is a must in places like Monrovia , where the power is less than reliable, and also outside the city center.
UNITAID is using the same model on CD-4 counters as it has used to help reduce the price ARTs and Malaria medicines. It uses its purchasing power (derived from a small levy on airline tickets in a few countries) to create markets for specialized technologies like powerless CD-4 counters.
Diagnostics are just one piece of a larger public health puzzle. Still, the lack of these tools adds a needless inefficiency to the public health system. In a resource stretched place like Liberia, proper diagnosis is one way to ensure that precious public health resources are used wisely.