Top three pieces of work - Part 1

It has been a busy few weeks after returning from the christmas break.

As my 6 month anniversary approaches, I would like to review the top three pieces of work on my plate at the moment. I hope this will also allow you to better understand the nature of CHAI's work. To treat each item in sufficient detail, I'll go through one of these each week.

Early Infant Diagnosis (EID) and ART initiation rates - HIV tests for adults is now easy and fast. These test kits are now ubiquitous in Uganda. Over 8 million HIV rapid tests are being issued out of the National Medical Stores to all the health facilities around the country. These tests work by detecting the antibodies your body produces to combat the virus.

Testing HIV exposed babies (where mother has HIV) is a little trickier as the baby is born with his/her mother's antibodies. A technique called DNA PCR is used for detection of the virus. This requires dried blood spots (DBS) to be sent to a lab, the blood to be extracted and the DNA to be replicated until sufficient copies are available for the machine to detect and identify the virus.

CHAI worked with the Ministry of Heath to implement a centralised high throughput laboratory with the capacity to serve the entire country. The intention was to develop capacity with the ministry and to reduce cost and turn around time for samples (went from around 20 days to a 3 days).

With over 7000 samples being processed monthly and results being sent back, the problem is now ART initiation. 50% of the HIV+ babies die within the first 2 years if they are not started on ART. Our analysis showed that only 23% of the HIV+ babies were actually initiated on ART.

A large loss, 39%, was getting results out to mothers. This is a tough one. Mothers don't return to the clinic unless the baby is sick and often it's quite late at that stage. We need to find a way to get mothers to come back for their results.

The second largest loss was getting babies on treatment after they have been referred from the post natal clinic to the ART clinic. Compared to the the previous loss point, this should be a no-brainer. Every HIV+ infant under 2 should go on treatment immediately. We met with all the partner (NGOs working in EID) to discuss why initiation is so low and what action we can take to improve the ART initiation rate.

Much work still needs to be done and I look forward to being part of it.