Innovations likely to improve healthcare this year

Proactive.  As we start the New Year, here are some health breakthroughs that started in 2023 and are likely to continue making a significant difference in the way people receive treatment.            

HIV self-testing kits

In December 2023, the Ministry of Health (MoH) launched a new HIV blood self-testing kit, which has been piloted and found effective for use among university students. The Health Minister, Dr Jane Ruth Aceng, says the test kit dubbed “Check Now” was developed by global medical device company Abbott and tested for effectiveness by the Uganda Virus Research Institute (UVRI).

Since 2018, the MoH has been implementing an HIV testing services optimisation plan that prioritises individuals at high risk to increase the HIV test yield. This is being done with approaches such as assisted partner notification, HIV self-testing and social network testing strategy.

Preliminary results from the 2020 Uganda Population-based HIV Impact Assessment (UPHIA) survey show that 81 percent of people living with HIV (PLHIV) know their status while 92 percent of PLHIV in Uganda have been linked to HIV care. While this is a marked level of performance, these findings suggest that up to 19 percent of PLHIV are not aware of their HIV sero-positive status.

To reach the remaining PLHIV with undiagnosed HIV infection, innovative HIV testing strategies, including HIV self-testing, are urgently needed to reach many of the population groups that have hitherto not been reached through conventional HIV testing services.

Joseph KB Matovu, a research associate in the department of Disease Control and Environmental Health at Makerere University School of Public Health, says when one tests HIV positive, they must confirm their results at the health centre in order for them to be linked to care.

“HIV self-testing services are freely available throughout the country, particularly at health centre IIIs, IVs and hospitals. The kit can also be obtained from pharmacies at about Shs35,000. However, the available number of kits is inadequate to meet the expected tarple despite the fact that nearly 60 percent of new HIV infections in Uganda occur in this age-group,” Matovu says.

There is a high acceptability of HIV self-testing (about 96 percent). However, only 78 percent of the users reported their HIV self-test results to providers. This presents a missed opportunity to link the testers to appropriate HIV prevention, care and treatment services.

However, it is important to note that HIV self-testing identified a high proportion of first-time HIV-positive testers (85 percent of those with confirmed HIV-positive results) with nearly universal linkage to HIV care.  

Herbal medicines

The use of herbal medicines in Uganda is rising, with new products entering the market each day. As a result of the high demand for herbal medicines, more local innovators, universities and pharmacies are also venturing into their production, medicinal herbs-related research and sale of the products. 

“This product relieves ulcers, a common problem among many people,” Carolyn Wambuzi, an employee of Jena Herbals, says, adding that the product is called Jenacid and is found in most pharmacies in the country.”

Wambuzi was one of the exhibitors at the National Science Week at Kololo Ceremonial Grounds in November, displaying products made by Jena Herbals, the company behind the renowned Covidex, a supportive treatment for Covid-19.

Many innovators with different types of herbal medicines were authorised by the Office of the President's Secretariat of Science, Technology and Innovations to display their products. Some products on display had received initial approval from the National Drug Authority (NDA) while others were yet to be approved.

“The product (Jenacid) is notified by NDA. It is a natural syrup, made out of herbs. It also does not have long-term side effects. It works by restoring your stomach walls, healing you naturally,” Wambuzi claims.

Notified?

A notified product is one whose manufacturer has submitted samples and details on its safety to the drug regulator who provides initial approval as the product awaits clinical trials as well as lengthy and expensive scientific procedure to prove cure claims. Records from NDA show that Jenacid was notified in December 2021.

Dr Michael Mutyaba, the manager of the herbal medicine division at the NDA, says it is registering an improvement in the quality of herbal medicines on the market.

Information from the NDA drug register as of October 2023 also indicates that the number of locally made herbal medicines that have been notified now stands at 292, an increase from 152 in 2020.

Dr Mutyaba attributes the improvement in quality to increased collaboration between the Natural Chemotherapeutic Research Institute (NCRI) of the Health Ministry, universities and herbalists.

Through these collaborations, herbalists are trained to ensure they improve the quality of their products since these products are tested for efficacy, " Dr Mutyaba says.

Blood irradiation

Although blood transfusion is a lifesaving procedure for people who are bleeding and those who cannot make a sufficient amount of blood on their own, transfusion-associated graft-versus-host disease (TA-GVHD) is a deadly infection that can ruin this lifesaving process.

When the disease occurs, the immune cells from the donor blood attack the recipient’s organs, usually causing death. This reaction arises from a type of white blood cells referred to as lymphocytes that are present in the donor blood product.

Dr Francis Ssali, the deputy executive director research and clinical services at Joint Clinical Research Centre (JCRC), says the condition presents 10-14 days after transfusion with a rash, deficiency of all blood cells and abnormal liver function. However, there is a longer time between transfusion and presentation in neonates (newborns).

The blood irradiation machine, acquired by JCRC this year could help prevent this complication. During the irradiation process, lymphocytes (white blood cells) present in a blood product are destroyed with x-ray  or gamma rays, preventing their ability to multiply or divide.

Since lymphocytes are white blood cells responsible for antibody production, regulation of the immune response and direct cell-mediated killing of virus-infected and tumor cells, this is an effective method to stop TA-GVHD. Dr Ssali says the facility can process 288 units of blood (48 cycles) a day, with an average patient wait time of four minutes, seven seconds.

“Radiation neither damages nor renders the blood product radioactive. This irradiation equipment uses safe x-rays that protect the environment. When the blood is treated with radiation, the damaged white blood cells are rendered incapable of dividing and, therefore, cannot cause any reaction in the body, ” says Dr Ssali.

Dr Leonard Nahwera, the head of radiology at the centre, says the blood bank only carries out leukoreduction, a process that involves the reduction of white blood cell (WBC) concentration in blood components, but is not sufficient.

He remarks that, “irradiation is only needed for people undergoing organ transplants, those with low immunity and neonates. Those who require constant transfusions such as those battling cancer or sickle cell anaemia can also take advantage of this service at Shs63,000.”

Online healthcare

Did you know you can speak to a doctor, get a prescription or get a hospital appointment online without necessarily waiting in the queue? Forget about resorting to Google for knowledge about your symptoms and landing on multiple blog links from unknown sources.

Now, you can get quality healthcare from trusted, skilled doctors and medical practitioners online.

One of the commonest Apps is the Seven Doctors App started in 2020. One can download the app on GooglePlay, giving you the ability to schedule appointments, chat with a doctor, get free health tips and search for specialist clinics.

Launched in 2012, Rocket Health offers convenient distance doctor consultations, lab sample pickups, testing, and pharmacy prescription deliveries.

Their telemedicine call centre proposes remote support to the population on sexual and reproductive health (SRH) issues along with an SRH focused self-servicing online e-Shop for easy access and last mile delivery to commonly stigmatizing SRH services such as condoms, emergency contraception and HIV self-testing in a private and confidential environment.

My Musawo app provides users with access to professional healthcare information, services, and products. Its mission is to make healthcare easily accessible and efficient for everyone, no matter their location.

With Musawo, the goal is to reduce the information gap in the community and give people the power to take charge of their health and wellbeing.

Others include Afya_pap, which caters for those living with high blood pressure or diabetes and GoGP that connects those in need through video chats.

Future

“The Ministry of Health should increase procurement of HIV self-test kits to increase the number of kits available to potential users and ensure equitable distribution across facility and non-facility settings,” Joseph KB Matovu, a research associate in the department of Disease Control and Environmental Health at Makerere University School of Public Health, says.

There is also need to institute innovative approaches that can reach adolescents and young people enabling them to access HIV self-testing services, including use of peer-to-peer distribution approaches.

HIV self-testing services should be integrated into the assisted partner notification programme to maximise opportunities for reaching sexual partners of HIV-positive patients.