Hi-tech Equipment at TB/HIV Care
brings Care Quicker to TB and HIV patients

28 July 2011

Professional Nurse Counsellor, Angelina Satira, takes a blood sample to perform a CD4 test	The PIMA machine prints out a CD4 result

Professional Nurse Counsellor (PNC), Angie Satira, walks comfortably with a small canvas bag slung over her shoulder. The bag contains the latest point-of-care technology - a PIMA machine. Little bigger than a large toaster, this machine is designed to provide CD4 results - the measure of a person’s strength of immune system - within twenty minutes. This promises to be a revolution in care for healthcare workers in the HIV field, such as PNC Angie Satira. In a laboratory in Kokstad, Collin Napier of the National Health Laboratory Services is preparing a small work space to receive a different machine – a GeneXpert – that will similarly radically transform the way in which he can diagnose TB in a patient. Both of these machines have been provided by TB/HIV Care Association through the generous funding of PEPFAR and TB Reach.

As a PNC working for TB/HIV Care Association, Angie Satira provides HIV counselling and testing services linked to screening for TB and STIs in a mobile team that travels the Cape Town metro. With a brand new PIMA machine accompanying the team, if someone at a factory or shopping mall tests HIV positive, Angie can provide them with a CD4 result within minutes. This means that if the patient qualifies for anti-retroviral treatment (ART), the process of initiating them on treatment can begin immediately. This speeds up the process of getting patients on life-saving treatment and closes the gap through which some patients become lost to care.

Without a PIMA machine, a patient who tests positive at a healthcare facility or a clinic will have blood drawn to be sent away to a lab. In an urban area, the CD4 results will be returned to the clinic or health facility within 24 hours, but patients can still get lost to the system if their phone number or address is incorrect. In rural areas, the waiting period for the CD4 results may be even longer, and there is even more risk of delays in the process of initiating the ARV treatment that they may desperately need.

At sites where Angie visits regularly, she finds that it is not only clients recently diagnosed as HIV positive who come to her for CD4 counts, but also clients who have already started on ARVs. These clients would rather visit her mobile team for their follow up CD4 counts than wait all day to be seen at a clinic. Angie then forwards the CD4 results to the clinic so that the clinic knows how well the patient is responding to their ARVs. The clinics also find this arrangement useful as it streamlines the flow of patients through their waiting rooms.

A microscope – part of the equipment currently used to diagnose TB,
a process that may take up to 6 weeks

The GeneXpert machine expected within the next week at the Kokstad laboratory provides a similar revolution in turnaround times for test results, but in its case, for TB diagnoses. Currently, people in the Greater Kokstad sub district of KwaZulu-Natal who have symptoms of TB will have a sputum sample taken at the clinic where they seek help. The sample is then sent to the Kokstad lab where technicians like Collin Napier perform smear tests under microscopes. The result of the test is then sent back to the clinic and a heathcare worker from the clinic must contact the patient within 48 hours. However, as with the delivery of CD4 count results, there are often problems in delivering TB test results to people in outlying or migrant communities where it is difficult for healthcare workers to find patients. In addition to this, a further test often has to be performed in cases where the smear test may not be reliable. Under the current system, if an HIV positive person with TB symptoms tests negative for TB, yet another test has to be performed – a culture test. For this test, Collin will have to attempt to grow a culture over the course of up to six weeks in the laboratory before the result is even known, let alone delivered to the patient.

The GeneXpert machine promises to change all this. Not only can the machine give a result more reliable than the smear microscopy tests, it can do so in under two hours. In effect, Collin will be able to send a result through to the clinic within 24 hours that is almost equivalent in reliability to the test that takes up to 6 weeks. In addition, Collin will also be able to diagnose drug resistant TB within those 2 hours, enabling the patient to start on the correct treatment immediately and reducing the opportunities for the disease to spread.

The excited NHLS team at Kokstad with representatives from TB/HIV Care Association:
From Left: Collin Napier (Kokstad NHLS), Mr Bandezi (NHLS), Faith Nompula (Kokstad NHLS), Gladness Marwa (Nurse Mentor TB/HIV Care Kokstad Sub district), Jenny McLoughlin (TB/HIV Care Site Manger KZN), Linda Erasmus (NHLS), Nomonde (NHLS), Zandile Cele (NHLS)

The GeneXpert’s placement at Kokstad is particularly important because of the high rate of co-infection of TB and HIV in the area and therefore where the need for 6 week TB culture tests is onerous. With the arrival of the GeneXpert, people in the area living with HIV, for whom TB is the most frequent cause of death, will have a much better chance of having TB diagnosed quickly and accurately and of starting on the correct treatment.

Both the PIMA machine and the GeneXpert are exciting technological developments that help to bring cutting-edge accuracy outside the laboratory and into, or that much closer to, communities. This means that, thanks to the support of PEPFAR, TB Reach and TB/HIV Care Association, communities are several steps closer to accessing appropriate TB and HIV care.

References:
TB/HIV Care Association, www.tbhivcare.org, 021 425 0050