ProACT: Stepping-up Laboratory & Diagnostic Services for an Improved HIV Response

Gabriel Chima. {Photo credit: MSH.}Photo credit: MSH.

The USAID-supported Prevention Organizational Systems AIDS Care and Treatment (ProACT) project provides HIV & AIDS treatment, care and community outreach with a full complement of laboratory services in 25 comprehensive care and treatment centers in six Nigerian States: Adamawa, Kogi, Kwara, Kebbi, Niger and Taraba States.

The ProACT Laboratory program helps to strengthen public laboratory institutions by supporting immunology, hematology, clinical chemistry, malaria, tuberculosis, HIV-testing and counseling services; strengthening quality management systems; and facilitating training and capacity-building for laboratory staff.

Here, Pro-ACT Adamawa Laboratory Systems Specialist Gabriel Chima discusses the project's laboratory services in Adamawa State. Chima has worked with the project for 16 months.

ProACT's role in broader Adamawa State HIV response

"The ProACT laboratory program has been pivotal in sustaining antiretroviral treatment (ART) and care in Adamawa State by monitoring ART and non-ART patients, providing capacity-building of laboratory staff, and ensuring quality laboratory services. We help determine drug regimens and also support the upgrade of laboratory infrastructure such as laboratory equipment. One of the state's laboratory policies is based on a lesson learned from MSH – procure equipment backed with a two-year renewable preventive maintenance contract from vendors. This moves us away from the era of purchase, breakdown, and dump. We have also recorded achievements in hospital waste management, and hospital staff members have received training through our partnership with AIDSTAR One. All the sites have improvised waste pits where there is no medical waste incinerator. Assuredly, one of the program's key achievements is improving the management systems."

Integrating pediatric HIV services

"MSH is the lead implementing partner for prevention of mother to child transmission (PMTCT) in Adamawa State. Currently, I am working on the complete integration of a dry blood spot (DBS) technique for pediatric HIV testing to ensure that the babies of HIV-infected mothers are closely monitored until 18 months of age. We discovered that the immunization program is working very well, so we can ride on this success by attaching DBS track-cards to immunization cards. Mothers and health-care givers will keep track of pediatric health data together.

Sample collection, transportation and results: the "bad weather option"

"We have worked also to align dry blood spot (DBS) sample collection and transportation from facility to the state hub at State Specialist Hospital, Yola. The MSH Laboratory Systems Specialist is charged with ensuring sample collection, transportation and results delivery to caregivers within an acceptable timeframe. To achieve this, I plan to use what I call the "bad weather option". Imagine this analogy: Mr. President is visiting Adamawa State. We are preparing for him to receive a 21-gun salute at a particular time of the day. Come rain or shine, the Brigade Commander must ensure that umbrellas are provided for Mr. President, who should not be soaked by rain while receiving the salute. In other words, the Brigade Commander must be well prepared!

Our "bad weather option" in the laboratory means reducing dependence on regular DBS sample transport routines. It involves coordinating with NIPOST (the Nigerian Postal service) for transporting lab samples. NIPOST will lift samples from the State Hub in Adamawa; deliver them to the Polymerase Chain Reaction (PCR) Laboratory in Jalingo, Taraba State; and collect results from the PCR laboratory to the DBS state hub, as a long-term sustainability measure. This is crucial since the electronic SMS (short messages) printers installed in the facilities are not receiving results, and the hospital's management are not releasing funds timely and regularly for DBS sample transportation and result collection.

I am presently making contacts to encourage the long-established government agency, NIPOST, supports pediatric HIV-testing, and PMTCT is a cost-effective and sustainable option. Preparations ensure that our "Mr. President" stays dry in the rain during a visit -- and most importantly, that the baby of an HIV-infected mother can receive timely and quality-care and support."

Read more about Nigeria's Pro-ACT project