Expedite enforcement of new HIV testing methods

In November 2024, the Office of the Director General at the Ministry of Health issued a circular directing leaders of hospitals and district health officials to adopt a new HIV testing algorithm that aimed to improve virus diagnosis accuracy and reduce cost per test. But six months later, this has not been implemented. The HIV testing algorithm refers to a specific sequence of laboratory tests used to diagnose HIV infection accurately. The new algorithm aligns with World Health Organisation (WHO) 2019 guidance recommending three consecutive rapid diagnostic tests (RDTs) to improve diagnostic accuracy using more affordable kits to reduce the cost per test, thus ensuring sustainability of the HIV response. WHO's three-test algorithm, adopted globally to address evolving HIV epidemiology, is critical for Uganda, where accurate testing is the gateway to treatment and prevention. Currently, there are around 730 new infections every week, with around 1.5 million people living with HIV.

The HIV prevalence has, however, declined over the years from 7.2 percent in 2010 to 5.1 percent in 2024, according to data from the Uganda Aids Commission. The delay in implementing the new algorithm has left health facilities and manufacturers who were preparing to supply the kits, in darkness, as cited in the April letter by one of the manufacturers, Wodfo, to the minister of Health. The manufacturer, whose kit was endorsed by the ministry for new algorithm, asked the minister to give clarification on reasons behind the delay. The 2024 endorsement by the ministry followed a 2023 evaluation of available HIV testing kits by the Uganda Virus Research Institute (UVRI) with Global Fund support. Our assessment shows that there has been a major shift in the country of origin for the kits. The country has been using Determine and Statpak/SD Bioline in the two-test algorithm. Determine and SD Bioline are manufactured by Abbott Diagnostics, whose headquarters are in America. Statpak is also a product of the US firm Chembio Diagnostic Systems.

Whereas sources within health commodity suppliers indicate that there is a conflict of interest among government officials in charge of clearing the procurement, officials at the Ministry of Health dismissed these claims. Dr Robert Mutumba, head of the Aids Control Programme at the Ministry of Health, downplayed concerns of internal disputes over suppliers, attributing delays to “normal bureaucratic consultations”. Dr Jane Ruth Aceng, the minister of Health, also says they won’t be coerced into action. Whereas the officials lead the planning and implementation, it's important to respect the evidence generated and advanced by both WHO and UVRI to endorse the new algorithm, assess and recommend the available RDTs for use in the response.