Laboratory Services Team
In order to properly treat patients you must first know what ails them. This seems like common sense and yet diagnostics pose one of the greatest and most neglected challenges. Consider that more than 50 percent of children born with HIV will die before their second birthday if they are not properly diagnosed and immediately put on treatment. Access to cost-effective, high-quality diagnostics is a major problem in resource-limited settings. People with HIV/AIDS, tuberculosis (TB), and other devastating diseases often do not get tested, and many who are tested still die while navigating insufficient referral and follow-up systems. For example, people enrolled in HIV/AIDS treatment programs are seldom tested for TB and other diseases that take advantage of weakened immune systems. According to the World Health Organization, less than five percent of people with HIV/AIDS are screened for TB despite the fact that TB is the leading killer of people living with AIDS.
CHAI takes a comprehensive approach to improving the diagnostics marketplace. We work globally with the companies that produce diagnostic technologies as well as locally with the governments who use them.
By helping diagnostic equipment companies forecast demand, better understand local markets, develop programs that reflect the needs of local markets, and identify cost-cutting opportunities, CHAI helps to reduce the cost of diagnosing patients. To date, CHAI has negotiated price reductions for all of the following HIV tests by between 30 and 80 percent: CD4, rapid HIV, and infant HIV diagnostics.
Today more than two-thirds of all infants who receive HIV testing in resource-limited settings do so through CHAI-negotiated price reductions. More than 8,000 facilities now diagnose HIV in infants, up from 200 when CHAI began this work. In 2010 alone, more than 375,000 infants were tested for HIV. More than 340,000 children are now on treatment – a sixfold increase since 2005.
South Africa rolled out the world’s least expensive HIV treatment monitoring program using a viral load test for which CHAI negotiated a 50% price reduction.
Point-of-care (POC) diagnostics have the potential to change the way care and treatment are offered to patients. POC allows patients to receive essential monitoring tests in one sitting, rather than having to return for a subsequent visit, and thus eliminates the back-and-forth time responsible for a substantial portion of patient loss. CHAI has worked with 13 governments to demonstrate a new POC CD4 test, an HIV monitoring test that determines patient eligibility for lifesaving treatment. Reducing patient loss increases the efficiency of national programs as resources are used for patients who actually benefit rather than being lost to the system’s inefficiencies.
Working with Governments
CHAI works hand-in-hand with governments on a wide range of policy, planning, and implementation issues to help strengthen their lab capacities. We look for ways to reduce diagnostic turn-around time and improve procurement and design systems to better serve patients. CHAI worked with the Chinese government to introduce public HIV testing across the country. In India, CHAI helped set up a more streamlined testing network that led to a tenfold increase in testing and treatment initiation. We were the first group to demonstrate the impact of point-of-care CD4 tests in reducing deaths that occur between diagnosis and treatment. We also worked with governments to introduce rapid HIV testing in Ukraine, The Bahamas, Papua New Guinea, and other countries. While HIV/AIDS has been our focus, the improvements in lab capacity support numerous other health interventions, and CHAI is now working to roll out new TB diagnostics.
Point-of-care CD4 testing in Mozambique reduced patient loss from 63 to 32 percent and increased the proportion of patients initiating lifesaving drug treatments from 11 to 21 percent.
Saving Lives through Technology
CHAI is using mHealth–mobile technology for health–to transform diagnostic systems in the same way that cell phones enabled Africa to leapfrog over landlines. In Kenya, test results used to be delivered by hand, taking weeks or months to reach the patient. CHAI helped develop an mHealth system that sends results from the lab via text message to a mobile printer at the local health facility in far less time. Health officials also have an easy-to-use dashboard that displays all samples and all positive test results in real time. Diagnostic turn-around time is dramatically reduced and the patient can be referred for treatment more quickly, reducing the number of people who die between diagnosis and treatment.
Building on Success
In the next decade we’ll see a huge increase in new health technologies. CHAI is uniquely placed between public and private sectors to ensure that new diagnostic technology is inexpensively and efficiently rolled out across the developing world. With the appropriate funding, CHAI can ensure that massive global investments in HIV/AIDS, TB, malaria, maternal and child health, and many other critical areas are not wasted because of ineffective diagnostic tools and systems.