The small PIMA device brings life-saving treatment to people living positively in Mwenezi District
5 September 2013 - Sister-in-Charge at Mwenezi District Hospital, Virginia Kudzerema walks comfortably with a small canvas bag slung over her shoulder. The bag contains the latest point-of-care technology – a PIMA device. Little bigger than a large toaster, this device is designed to provide CD4 results – the measure of a person’s strength of immune system – within twenty minutes. The new technology has revolutionised the care of those living with HIV in Zimbabwe.
As the only referral hospital in the district, Mwenezi Hospital is always busy with patients seeking treatment, HIV counselling and testing and screening for tuberculosis (TB) and sexually transmitted infections (STIs) – conditions which are very time sensitive.
Virginia, one of the hospital staff members trained under the Point of Care Programme with the support of UNICEF and the Clinton Health Access Initiative (CHAI) to use the PIMA, says the device has been novel when treating people living with HIV in the district.
With many medical personnel cautious to start patients on antiretroviral treatment (ART) without evidence that their CD4 count has dropped below 350 – the threshold for treatment initiation in Zimbabwe – the faster results has meant quicker access to life-prolonging drugs for many people living with HIV.
“Before providing treatment of any opportunistic infection these days we encourage patients to be tested for HIV first before getting treatment – and if they test positive and agree to go on treatment we usually have their CD4 results within minutes. This means that if the patient qualifies for ART, one can start initiating treatment right away,” said Virginia.
The simple PIMA device has eliminated long and tedious steps in the process that patients in Mwenezi used to go through in order to be initiated onto life-saving treatment. As explained by Virginia the device has effectively closed many of the gaps through which patients were lost to care.
“Without a PIMA, a patient who tested positive in the past used to have their blood drawn and sent away to a lab at Masvingo Provincial Hospital – about 200 kilometres away. Unlike in the urban areas where the results could be obtained quickly – patients here used to wait for more than two weeks or more depending on the backlog at the Provincial Hospital.”
“The lag in receiving the results increased the risk of delays in the process of initiating the ART treatment that many of the patients needed desperately. But now the PIMA device has moved right into the testing site and is saving lives that could have been lost in the past,” said Virginia.
In addition, the PIMA device has also reduced the time it took to start infants on ART treatment as part of a national prevention of mother-to-child (PMTCT) HIV transmission services by about four months and has further reduced the numbers of new mothers who disappear from the hospital’s PMTCT programmes during the long waiting times or after having spent time and money on multiple visits to clinics and hospitals to check for results.
The initiative as witnessed at Mwenezi District Hospital has led to a marked increase in the number of people who have tested positive, and more importantly, being put on treatment as quickly as possible. Other HIV-positive clients already on treatment are now constantly visiting the hospital and other local clinics to get their CD4 counts and ensure their treatment is working. This means that people do not have to wait in queues all day – waiting to be tested and then receiving their results. The PIMA device has also reduced the hospital workload as other patients are now being treated at their local clinics which have received these lifesaving devices.
On the demand side however, Mwenezi District Hospital has learnt that the introduction of the new technology is driving up the demand for drugs as more people are being initiated more quickly on ART treatment than before. As a result, the hospital’s entire drug supply chain has had to be examined to ensure it can cope.
The PIMA device comes in a small package, but gives a powerful boost to the medical personnel at Mwenezi District Hospital’s ability to provide same day, on site availability of CD4 count, and then immediate referral for antiretroviral treatment or post-test counselling for all that need it. Anyone testing positive is quickly entered into a system of HIV care and support – in the process saving the lives that would have otherwise been lost in the past.