Reducing medical test delays from 30 days to 30 seconds (Part 2 of 4: Innovation in Zambia)

Today I got to see a project which I’ve talked about a lot but never seen in real life.

UNICEF’s Project Mwana is a system for sending medical results quickly to remote areas.

In Zambia, and many other places with a large number of HIV infections, it is critical to know the HIV status of newborn infants. The test that you need to do to check, though, is difficult.

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A box of materials for running PCR tests on dried blood spots (Fabian)

An “Early Infant Diagnosis” test requires two things: a small sample of dried blood from the baby’s foot, and a PCR machine to analyze the DNA. Those two things exist in very different worlds.

The baby’s foot is pricked in a village in rural Zambia. A place with no paved roads, little or no access to electricity. It often takes more than 30 days for the paper with a spot of blood on it to make its way to Lusaka for testing.

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Dried Blood Spots (these five spots are from a pricked foot of a baby, drying in the air, then sent on a long journey to a testing facility). (Fabian)

The PCR machine exists in the University Teaching Hospital (and two other locations in Zambia). These machines are manned by highly trained technicians, and allow for the small amount of DNA on the paper blood spot to be analyzed for the HIV virus.

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Test preparation machinery for the DNA extracted from DBS’s at University Teaching Hospital (Fabian)

After this is done, it is vital to get the test results back to the mother and a health worker in the village. If the baby is HIV-positive, it must go on anti-retroviral drugs immediately. Without anti-retroviral drugs 50% of HIV+ infants will not celebrate their second birthday. 75% will be dead before their third.

This journey was taking at best 66 days. That is more than a month for the sample to get to a PCR machine, and another month for the information to get back to the village. This amount of time, when you’re waiting for test results that can save your baby’s life, is unacceptable.

Project Mwana has cut this turn-around time by half –and sometimes even more. UNICEF, with the government of Zambia, and a constellation of great partners, uses Mwana to send test results instantly.

Project Mwana also allows the government to see which health clinics are performing well – where there is backlog, or where additional training might be needed.

At the University Training Hospital we watched the blood samples get punched (with a hole-punch) from the paper card, mixed with reagents, and run through a set of processes that allowed the DNA samples with HIV markers to be identified.

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A nurse at University Teaching Hospital carefully punches Dried Blood Spot samples into test tubes (Fabian)

We also saw the test results entered into a web-based system – and sent instantly by text message to the rural clinics where the tests had first been taken.

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Film crew capturing test results being entered into a database, and automatically queued to be sent via SMS back to health centers – an instant data channel (Fabian)

This system isn’t everywhere – it has particularly been put in place in the most difficult to work in areas of the country. This is important, because these are the clinics that are experiencing the greatest delays in getting results, and the greatest gaps in treating infants in time. It also is a factor of UNICEF’s equity focus –we know that by focusing on the hardest environments we create network benefits for the entire country.

This system cuts the time for a mother to get her child’s test result in half – 66 days (at best) down to 33 (on average). More than that, it cuts the time for the return journey from approximately 30 days down to seconds.   These type of systems can apply equally well in other health markets – anywhere in the world where it takes too long to get vital information back from formal systems – and are an improvement we can all appreciate.

Chris
@unickf
Lusaka
19 March, 2014

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Related stories:

WHO publishes Zambia results of using SMS to improve early infant diagnosis of HIV infection

Project Mwana on Change Observer

UNICEF profiles Mwana partnership

UNICEF’s Mwana wins two IDSA awards

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