HIV diagnosis in Uganda has evolved
Yusuf Muyingo
Last week, we celebrated World Aids Day. It’s important to note that Uganda became the first African country to identify ‘Slim Disease’ in 1982 in Kasensero fishing village on the shores of Lake Victoria of Rakai District and later recognised as Aids in 1985.
March 2, 1985 marked a key milestone in the fight against HIV due to the approval of the first-ever test for exposure to HIV by the US Food and Drug Administration (FDA). This was an unequalled scientific breakthrough in the speed and accuracy of detecting HIV in blood, at a time when fear was high and many myths prevailed.
Due to the very high rate of HIV infection in Uganda during the 1980s and early 1990s, there was an urgent need for people to know their HIV status which by then, The National Blood Transfusion Service was the only option available because of the transfusion services it offers.
In 1990, Capillus HIV-1/2 (Cambridge diagnostics) agglutination antibody screening test was introduced. It was key in the diagnosis of HIV/Aids. More strides were underway not until 1997, when Confirmatory testing of all positives by capillus HIV-1/2 which was conducted using Serocard (Trinity Biotech), was introduce. The discrepancy of Capillus and Serocard led to the introduction of a Multispot Test (Sanofi Pasteur Diagnostics) as a tiebreaker.
Several challenges were identified with the existing algorithm and the test kits including first, refrigeration of kits which is not often unavailable at rural hospitals and health centres. Second, the packaging of 40 or 50 tests in a “tie-breaker kit” which meant that sites with low volumes would utilise fewer kits given the small numbers to perform confirmatory test hence the kit would expire before all tests are used.
In order to avoid/reduce wastage a single-use kit that could be stored at room temperature, was required. These led to the introduction of a new algorithm in early 2000s with Determine for screening, stat pack for confirmation and Unigold used as a tiebreaker in case of the discrepancy of the first two.
Recently in 2018 the testing algorithm was further adjusted to fit the accuracy, timely and affordable results to the population when Unigold was replaced with SD BIOLINE as a tiebreaker. According to WHO, to ensure accuracy and reliability of HIV results, the term inconclusive was introduced for all antibody tests to ensure reproducibility of the results on the same patient. This has been beneficial to lots of individuals since proof checking of results is done more than once to label the status outcome of the HIV testing as negative or positive. Further models have been introduced to increase access to HIV testing services and care which include Index testing, diagnostic counselling and testing, HIV self-testing, Intimate Partner Violence(IPV), individual counselling, couple counselling, social network testing and prevention of mother to child transmission (PMTCT).
Ministry of Health (MOH) and its partners also launched HIV Recent Infection Surveillance, which encompasses testing newly HIV-diagnosed persons using a rapid test for recent infection (RTRI), Asante. The HIV Recency test provides insight into the timeline of HIV infection in an individual. Individuals infected approximately within the past 12 months (‘recent infections’) have high levels of viral load, making them more likely to transmit the virus to their sexual partner(s) and babies
As of December 1, 2022, The evolution in HIV diagnosis marked the increased number of testing sites (approximately 4,500 facilities) with a minimum of two testers in each under the current national programme of Site and tester certification by Uganda Virus Research Institute (UVRI) in order to promote the access to testing and quality care of HIV in Uganda by every individual. The role of the laboratory in timely detection hence prompt diagnosis and surveillance is a greater contributor to the success of containing high prevalence rates of HIV among other diseases in the country and world over. We take this opportunity to thank all the medical laboratory professionals in their respective capacities for the good work they have continued to exhibit. Let us continue to discover the unknown.
Mr Yusuf Muyingo is the Secretary General, Uganda Medical Laboratory Technology Association.
