By Lyndal Rowlands and Mercedes Sayagues
UNITED NATIONS, Dec 29 2014 (IPS)

In rural Zambia and Malawi, new mums face long delays finding out if they have passed HIV on to their babies.

Without treatment, a third of babies born with HIV will die before their first birthday and half before their second. Starting treatment within the first 12 weeks of life vastly improves their chances of survival.

But testing babies is not easy in poor countries.

Because mothers pass antibodies to their babies in the womb, the usual adult antibody tests during the first months of life can be inaccurate.

A virological test is needed. But only a handful of central labs can do these in Zambia and Malawi. On the long journey to and from the lab on the back of a motorbike or truck, the blood sample or the result often gets lost.

Some studies suggest that nearly half of tests never reach the clinics or the mothers.

Meanwhile, the new mum returns to her village and she and the baby likely drop out from the clinic’s radar.

Malawi and Zambia each has an estimated one million people living with HIV. In 2012, new HIV infections among children numbered 9,400 in Zambia and 11,000 in Malawi. Just over one third of babies were tested.

The old system couldn’t cope. New ideas and technologies were needed.

Enter UNICEF Innovation with an open source, code-based RapidSMS software: as soon as the lab result is in, the rural clinic’s nurse receives it by SMS on a cell phone or looks it up on the website. In remote villages, a community health worker receives the SMS and alerts the parents.

All information is encoded to ensure privacy and the software includes a web dashboard for reporting and administration.

In Zambia, the turnaround was cut from two or three months down to one month, said Shadrack Omol, deputy representative of UNICEF in Lusaka.

The SMS relaying is part of an antenatal system, Project Mwana (KiSwahili for child), that brings other benefits for all new mums as well.

At the first antenatal visit, the mother’s details are entered in Mwana’s SMS reminder system for alerts on checkups, immunizations, baby weighing and drug refills.

Bundling the HIV component with regular mother and baby care helps avoid stigma and fear of being identified as HIV positive.

In 2011, a Mozambican charity with 22,000 people on ARV treatment tried to build a cellphone database to remind patients of appointments: fearing loss of privacy and stigma, only half gave their cellphone numbers.

In Zambia, Mwana covers 484 clinics in 10 provinces. In Malawi, it has delivered more than 20,000 tests.

The next step, says Emanuel Saka, HIV specialist with UNICEF in Malawi, will be “expanding the geographical coverage and scope of the technology” and targeting adolescents with HIV.

New solutions to old problems

The best solution would be to test babies at the point of care in the rural clinic without any delays. In Mozambique, health workers are trying out a new viral load testing machine that can diagnose young babies in less than one hour.

“This is a great breakthrough,” said Bindiya Meggi, a pharmacist working on this project with the National Institute of Health.

Made by the German company ALERE, the machine is being tried in four sites with the help of the Clinton Health Access Initiative.

“It’s very simple to use,” said Ocean Tobaiwa, a Zimbabwean technician at the trial clinic in Maputo

As the machine is tested, it is adapted to local conditions, such as irregular electricity, black outs, power surges, heat and humidity. German technicians visit regularly to tweak the machines.

At present, babies are tested at one-month of age. A dry blood sample is collected through a heel or finger prick and sent to a central lab for viral load analysis.

Mozambique has only four such labs for a population of 24 million, with some 900,000 HIV positive women, and thousands of kilometers of roads impassable in the rainy season.

Although in theory results should be returned in two weeks, the reality is one month or more. Meanwhile, as in Zambia and Malawi, mother and baby are lost to follow-up.

In Zambia, RapidSMS is the backbone of U-Report, a booming HIV hotline service for young people, which garnered 71,000 users in two years. (see sidebar)

UNICEF Innovation Labs work with universities and the public and private sector to find new solutions to old problems in health, education, and water and sanitation.

“There is so much to do in the area of technology and real time information that hasn’t yet been explored,” Kochi said.

Soon parents in rural Kenya will be able to receive the HIV tests results of their infants as soon as the relevant blood tests have been done. Credit: Isaiah Esipisu/IPS

By Isaiah Esipisu
NAIROBI, Feb 20 2012 (IPS)

Jesse Mtembe, a nursing officer at the Akithenesit Health Centre in Teso North, in Kenya’s Western Province, cannot wait for his centre to be connected to a new software system for diagnosing HIV in infants that is being developed in the country’s leading private university.

Soon Mtembe’s patients will be able to receive the HIV tests results of their infants as soon as the relevant blood tests have been conducted at one of the country’s central laboratories some 200 kilometres away. Currently parents in rural health centres wait up to 18 weeks for the blood test results.

Since 2011, students at Kenya’s Strathmore University have been developing and refining software of infant HIV diagnosis. The software has been implemented in 75 health centres in the remotest parts of the country as part of first phase trials.

The software seems simple enough. Once blood samples arrive at one of the country’s four central Kenya Medical Research Institute (KEMRI) Centre for Disease Control and Prevention (CDC) laboratories all samples are logged into the system. Once this is done, the software automatically generates a short message service (SMS) to the rural health centre the sample was sent from to confirm receipt.

Once diagnosis has been completed, the system generates another SMS to confirm this, and if the result is negative, the results are also given. Results are received in rural areas on SMS printers and parents are notified by the clinic that their results are ready.

“On the SMS printers that we have already installed in rural clinics, we only send negative results in real time. This is because as a policy, all positive results on the polymerase chain reaction (PCR) equipment have to be re-run for confirmation in order to avoid false positives that might be due to contamination,” said Oscar Mulondanome a lab technologist at the Alupe Centre, one of the country’s testing laboratories.

Unlike other HIV testing methods such as rapid tests, where a patient receives the results after a few minutes, testing for the virus in infants requires the PCR technique, which is used to amplify the genetic make-up (or DNA) of a single or a few HIV viruses.

In Kenya, early diagnosis in infants is conducted with the support of the National Aids and STIs Control Programme and the United States Army Medical Research Unit. The project is being funded by the Clinton Health Access Initiative.

“The database application has allowed real time analysis of data generated for active interventions and has a wide geographical coverage,” Silvia Kadima, a research scientist at the KEMRI HIV laboratory, told IPS.

“We are projecting that by April this year, the software tool will be customised to Kenya’s local needs, and that is when it will be officially launched and rolled out by the government,” said Kadima.

She said that 50 more facilities would be connected for further trial phases before the product is officially rolled later this year. Kenya has a total of 904 listed public health centres all over the country.

The system is a welcome relief to far-flung places like the Akithenesit Health Centre.

“Given the location of our health centre in a remote area, we have to rely on lifts offered by officers from the nearby military camp to transport the samples to (the Alupe Hopsital in Busia) some 200 kilometres away, where there is an infant HIV testing centre,” Mtembe said.

It is a journey that takes a minimum of 10 hours because of the poor state of the road.

“After a few months, we then go through the same route to collect the results. And if they are not ready, then we have to organise another trip on another day,” said Mtembe, who is also head of the centre, which only has three nurses.

However, in Kitui County in Eastern Province, residents say they are already experiencing the impact of the system.

“For my first two babies, I received their HIV test results 18 weeks after the blood sample had been collected, and this was given during the routine postnatal clinic visits. But for my third born, I received an SMS on my phone five days after the sample collection, asking me to collect the results,” said Elizabeth Mwende a resident of Mutomo village in Kitui.

The 17-week difference in receiving an infant’s HIV results is key to effective treatment.

“Diagnosis of infants within six weeks of birth allows timely initiation of anti-retroviral therapy (ART) of children below two-years-old and can save lives. Without ART, up to 50 percent of children who acquired the virus from their mothers, would usually die before the age of two,” said Dr. Lucy Matu of the Elizabeth Glaser Pediatric AIDS Foundation.

“Early infant diagnosis allows for early and timely intervention. If a kid from an HIV-positive mother turns out to be negative, then proper preventive measures will be put in place to ensure that they do not acquire the virus at all,” added the Prevention of Mother-to-Child Transmission adviser at the foundation.

(END/2012)