ŠUNICEF/Malawi/Khangamwa/2015
A health worker at a rural clinic in Malawi uses a point-of-care diagnostic machine to run a rapid test for a baby exposed to HIV.
HIV-exposed infants receive a virological test for HIV within four to six weeks after birth. Without immediate access to treatment, approximately 30 per cent of children living with HIV will die within the first year of life, and 50 per cent will die before they reach their second birthday.57 Availability and access to HIV diagnostics for children are major bottlenecks to starting treatment promptly. The introduction of a new generation of point-of-care (POC) diagnostics, now WHO pre-qualified for routine use, can break through these bottlenecks, dramatically expanding access to treatment and improving service delivery. Previously existing options for early infant HIV diagnosis (EID) and viral load (VL) screening to monitor viral suppression used complex, laboratory-based technologies that required specialized personnel. As a result, they have not been able to meet testing needs in resourcelimited settings and reach remote populations. Despite efforts to strengthen conventional systems, including the use of dry blood spots for sample transportation from clinics to centralized laboratories, limitations often lead to long turnaround times, high rates of loss to
24 | Seventh Stocktaking Report, 2016
follow-up, test results that do not reach the patient and delayed treatment decisions. A new generation of point-of-care (POC) diagnostics can break through bottlenecks, dramatically expanding access to treatment and improving service delivery.
The new POC diagnostics are a game changer. UNICEF and the Clinton Health Access Initiative, with financial support from UNITAID, are working on both the supply and demand sides of the market to increase the availability of a new generation of POC diagnostics for CD4, EID and VL, with the goal of shortening the turnaround time from test to result so that patients get their results the same day. Experiences with CD4 thus far indicate that POC testing can substantially improve access and service delivery. With same-day test results, POC testing reduced the number of times patients needed to come to health facilities before starting treatment (based on previous WHO guidelines), reducing the burden on patients and opportunities for patients to drop out. Same-day test results also empowered clinicians to provide more comprehensive clinical assessment when patients came for routine visits.