As the world comes together to try and tackle HIV/Aids, an initiative by the African Society for Laboratory Medicine (ASLM) and UNAIDS is rooting for laboratory services to be placed at the forefront of the fight.
The Diagnostic Access Initiative aims to have 90 per cent of all people living with HIV/Aids diagnosed and on treatment by the year 2020, as well as ensuring 90 per cent of people receiving antiretroviral treatment (ART) achieve viral load suppression (having almost undetectable levels of the disease in their blood).
The target is high and 2020 is less than six years away, but Rwanda is in good shape to reach the finish line.
“The goal may sound ambitious, but it’s achievable,” said Trevor Peter, the chair of the ASLM board of directors.
He said in recent years there has been a lot more investment into laboratories around the world, and services have been improving, but countries still aren’t at the level they need to be.
The initiative is meant to take those services to the next level.
The initiative will be running in partnership with the World Health Organization (WHO), the Clinton Health Access Initiative (CHAI), US Centre for Disease Control and Prevention (CDC), Unicef, and the US President’s Emergency Plan for AIDS Relief (Pepfar).
Peter said he is impressed with Rwanda’s progress providing HIV/Aids care.
“Very few countries in Africa have achieved what Rwanda has been able to do,” said Peter.
According to UNAIDS, 90 per cent of people living with HIV/Aids in Rwanda have been diagnosed, meaning that Rwanda has already reached the first goal of the new initiative.
The most up to date numbers from the Rwanda Biomedical Centre indicate that 69 per cent of people living with HIV/Aids are on antiretroviral treatment, and 82 per cent of those who are on treatment have achieved viral load suppression.
Indicator of lab boost
Justus Kamwesigye, strategic information adviser at UNAIDS, said Rwanda’s success in getting people on ART and keeping track of viral load suppression is a big indicator that the laboratory services in the country are strong.
“When you get to the stage of care, most of it can’t be done without a functioning laboratory, and we continue to see the enrolment of people on ART which means people are being monitored,” said Kamwesigye.
“This is an indicator that the laboratory services are working.”
However, he said there is always room for improvement, especially when it comes to funding.
“The lab is an expensive venture,” said Kamwesigye. “Most of our funding is coming from outside sources like the Global Fund and Pepfar; any slight change in funding from donors can have a huge effect on the programme.”
He said Rwanda needs to look at more sustainable funding options for HIV/Aids care programmes.
Peter agrees that funding has a lot to do with the success of care programmes, but said it is not the only thing that determines good outcomes.
“It’s not just about funding, it’s also about innovation. We need to think about new models and how to achieve better accessibility,” Peter said.
He said this means bringing treatment closer to the people so they don’t have to travel long distances to access testing or follow-up on treatment.
The number of health facilities in Rwanda that provide testing and ARTs have gone up significantly since 2010, bringing treatment closer to home for a lot of people.
Sabin Nsanzimana, head of HIV division at the Rwanda Biomedical Centre, said all advanced tests, including diagnosis and follow-ups, are done in the country.
In 2010, there were 419 clinics that did testing and counselling, and 295 that provided antiretroviral therapy. Last year, the numbers increased to 493 and 465, respectively.
Currently, 93 per cent of people who are eligible for ART in Rwanda have access to treatment. However, this is based on old eligibility criteria. HIV attacks and kills cells called T-helper cells, which are important to the immune system because they organise all the other cells to help ward off illness.
A low count of T-helper cells (CD4 count) makes people vulnerable to diseases because their immune systems become weak. Someone not infected with HIV has a CD4 count of between 500 and 1,200 cells per cubic millimetre of blood.
Before May of this year, only people who had a CD4 cell count of 350 or less were able to get treatment, but the World Health Organisation eligibility for ART changed to include people with CD4 cell counts of 500 and lower.
Kamwesigye said this means the percentage of people receiving ART will increase, although they won’t be able to get everyone who is eligible for the treatment on it right away.
He suggested that most of the goals of the Diagnostic Access Initiative are realistic for Rwanda, but their biggest challenge will be with access to ARTs.