Expanding the Accessibility of CD4 Cell Counting Test for HIV Treatment

Project location: Kenya, Nairobi
Project start date: July 2010 - Project end date: July 2011
Project number: 2010-35
Beneficiary: Facts in Action International

FINAL REPORT

The second phase of the project has been met with a lot of enthusiasm by both the beneficiaries and the personnel at the patient support centers. The project has seen the first group of beneficiaries streaming into the laboratory from the month of June. The clients are received promptly and warmly at the laboratory reception. The phlebotomist is informed so as to usher the client into the phlebotomy room. At this point the client is given an overview of what to expect; that includes the venepunture procedure, the eventual dispatch of test results to the requesting doctor and what to do in the future visits. Thereafter the client is identified with the aid of the CD4 patient Identification list (which we dubbed PIL). The patient Identification list is a register that contains the patient's full names, age, sex and identification number. The identification number herein is the same number that the patient uses at the patient support centre or clinic for issuance of the free anti retro-viral drugs. The Patient Identification List was generating in the first phase of the project using existing records kept at the local clinics for issuance of free Anti Retroviral drugs through the government run HIV programme. Once the patient's identity is verified, the phlebotomist performs a venepunture procedure to obtain a blood specimen. The specimen is labeled immediately in the appropriately manner using a barcode. The patient is then released shortly. The phlebotomist proceeds with the preparation of the blood specimen at the specimen preparation bench in readiness for it to enter the analytical process. After that the prepared specimen is stored at 80C awaiting analysis. During the morning hours the technologist performs the Quality Control and validation of the reagents on the CD4 Fascount analyzer to ensure that the instruments performance is within the acceptable performance range. Before the end of the day, that is late afternoon, the technologist commences analyzing the specimens received earlier in the day, in a batch. After the test results are out the technologist validates them for accuracy and presents them for authentication by the pathologist. The dispatch personnel transmit the authenticated reports to the requesting doctors(s) in the various patient support centers and clinics. The results are dispatched in two ways either electronically for end users who enjoy internet connectivity or are hand delivered the following morning. The courier personnel commence delivery as early as 0900 hours. No reports are ordinarily issued to the patients unless under special circumstances where delivery may be impractical. In addition, any test result that is flagged as "high Priority" is dispatched as a matter of priority through email, facsimile machine or urgent hand delivery. The requesting doctor is notified on phone prior to sending them. In this case the technologist uses discretion and is responsible for ensuring that these categories of test results reach the doctor within the shortest time possible.

The general turnover of the beneficiaries has been generally good, some even making random visits to know the location of the laboratory and a few other details. The nearness of the laboratory has made it easy for the beneficiaries to reach without having to spend much on transport costs. From the time the first beneficiaries were attended in to the laboratory up to now, over two hundred and fifty specimens have been run which translates to an average of twenty per day. The doctors are also happy with the turnaround time and delivery of the reports. One doctor has commented positively on the intervention saying that is like a reprieve from blind diagnosis.

In a nut shell, the project has made it easier for the beneficiaries to have easy access to the CD4 testing services at an affordable cost, while the doctors have a more refined approach in diagnosis by way of assessing the effectiveness of Anti Retroviral therapy and the health of the patient. The doctor also uses the CD4 count as an indicator of when to commence therapy in recently diagnosed HIV positive cases. The drug combination recommended depends largely on the severity of illness based on the CD4 count. It is therefore imperative for the doctor to have a CD4 test result to enable him prefer the correct drug combination for each patient. As a long term benefit, the persons living with HIV/AIDS shall be able to enjoy better health through reduction of opportunistic illnesses, reduction of man hours lost seeking for treatment, increased economic productivity and enhanced survival rates. The prolonging of lives reduces the number of orphaned children who lose their parents to HIV related complications.

Nonetheless all this effort has not been without challenges. The field officers have been able to reach majority of the targeted beneficiaries in their homes and at the patient support centers. However, they are yet to get into contact with a few who for some reasons are not within reach and/or have not availed themselves at the patient support centers to pick up their next prescriptions of anti retrovirals. For that reason the project management team has seen it fit to allot an extra month to two field officers, who shall continue to explore other avenues of reaching the beneficiaries who have not been reached at this point.

A second challenge the project is facing is the lack of an inexpensive means of delivering the hard copies of the test results. The organization intends to purchase a motorcycle for the purposes of delivering the specimens easily and quickly. This has two advantages. One it will cut back on the cost of using external courier services, which have been currently contracted to deliver test results in areas where our internal courier is unable to reach via public means. Secondly, the amount of money spent on public transport for our delivery personnel is high, and the use of a motorcycle will certainly save on time and transport allowance. The motorcycle does not consume much of fuel and is economical in maintenance. The project management team has organized for one dispatch rider to undertaking a motor cycle refresher course for him to be issued a renewed license, since he has not rode a motorcycle for some time. The organization is planning to purchase a motorbike as soon as funds are available.

A third challenge the project faces involves the HIV positive community members who are requesting to be considered and enrolled into the program. At the moment they are not denied services but they are required to pay for the full cost for the CD4 test. They are requesting the organization to consider enrolling them so that they enjoy the benefit of a subsidized price. This scenario has been challenging owing to the fact that some women enrolled in the program have infected partners. Although the organization deals primarily with women living with HIV/AIDS, the project team has presented the matter to the board for them to sit and determine the outcome. Children identified during the short listing phase were all enrolled into the program regardless of age and sex.

Lastly, the organization remains optimist that the project will be of utmost benefit to the persons living with HIV/AIDS and that more funds and machinery can be sought so as to institute more CD4 laboratories in other locations where the need is immense.