"We have managed to reach the 95% target because we are managing to collect the Viral
Load samples and we are managing to get the results of the tests.”
By Michael Gwarisa
To fast-track progress towards ending AIDS by 2030, Zimbabwe has increased Viral Load (VL) testing coverage in almost all 63 districts, following the rollout of an Integrated Specimen Transportation (IST) system.
The widespread rollout of the IST system commenced in 2021 and has since spread to all 2000 health facilities under the Ministry of Health and Child (MoHCC). The project is being implemented by the Ministry of Health, through the Biomedical Research and Training Institute (BRTI) and is financed by the UNDP/Global Fund project.
The IST project uses a hub and spoke model where Bikers and drivers transport specimens from lower-level facilities (Spokes) that are organised into clusters, to district/mission/rural hospital labs, (Hubs).
Director of Laboratory Services in the Ministry of Health and Child Care, Dr Riva Simbi, said the IST program has greatly reduced the Viral Load results turnaround.
We were using HIV Viral Load as a tracer test and we have managed to reduce our turnaround time to as more as three months to almost 11 to 15 days. In some instances at the lower levels, we have reduced even to a single day because of information systems that we have also deployed with the IST system,” said Dr Simbi.
Before the rollout of the IST, the turnaround time for Viral Load testing was around 50 to 60 days and this according to Dr Simbi compromised the quality of samples.
He added that the system has a sample tracking system where the sample can be tracked real-time as it is being ferried from the lower level facilities to either the lab and or district, provincial hospital
“We also now have an electronic turnaround time where results are sent electronically to the clinicians and also some messages are sent straight away to the patient. This system has improved our laboratory system in terms of testing and now we can account for most of the samples.”
By strengthening Zimbabwe’s IST system, significant improvements have been made in delivering timely and effective treatment, including HIV treatment, ultimately improving patient outcomes and overall public health.
Zimbabwe is among the few countries to have attained the 95-95-95 UNAIDS target ahead of schedule and the IST program is set to leap-frog the country towards epidemic control.
Chiedza Mguni, the BRTI Technical Lead Clinic Laboratory Interface said the IST program has been a game changer by increasing the number of Viral Load specimens that are transported from about 400000 per year to over a million.
“The national viral load coverage has also jumped from around 40% to 85% due to increased access to diagnostic testing. Prompt patient management has been made possible due to decreased Result Turnaround time from 3-6 months to 2-3 weeks from the time of specimen collection at the facility and result returning to the facility,” said Mguni.
She added that the IST program has been instrumental in reducing the specimen rejection rate from 3% to less than 0.5% which is a good thing as it means that most specimens received at the laboratory are suitable for diagnostic testing as IST ensures that specimen integrity is maintained during transportation.
“This results in accurate and reliable test results improving patient management and clinical decision-making. IST has significantly contributed to the attainment of the UNAIDS 95-95-95 goals well ahead of the 2030 target”
In Bulawayo, the delivery of specimens to the main Laboratory and Mpilo Hospital has greatly improved and viral load samples contribute the biggest chunk of the samples they receive and process daily.
“We have registered an increase in the number of specimens from 5000 samples to 10000 samples per month through the IST program. This is a combination of Sputum for Tuberculosis, Viral Load and many others. We have greatly improved our turnaround time and coverage for samples,” said Dr Narcisius Dzvanga, Chief Medical Officer of Mpilo Central Hospital.
The IST have also improved treatment monitoring and diagnostics not only for HIV and AIDS but also for infants born with or exposed to HIV, TB patients, and various other illnesses.
Meanwhile, the Midlands province is among provinces with the highest Viral Load testing coverage at the back of the IST program. Dr Prince Pedzisai, the Midlands Acting Provincial Maternal and Child Health Officer said Viral Load is one of the best-performing indicators in the province.
“Because our specimens are getting to the lab and because the lab is managing to generate results that are also getting to the facilities timeously, we have noted that some of our indicators are doing much better. For example Viral Load Coverage. We have managed to reach the 95% target because we are managing to collect the Viral Load samples and we are managing to get the results of the tests,” said Dr Pedzisai.
He added that the IST project has left a footprint within the Midlands province in all eight districts. The facilities within the district are visited at least three or four times per week, the riders get to the facilities to collect the specimens as well as delivering results. This according to Dr Pedzisayi guarantees that every specimen that we collect at the facilities gets to the lab.
Mr Evidence Makombe, the Midlands Province Chief Scientist stationed at Gweru Provincial Hospital said they processed a total of 23,000 Viral Load samples in April and approximately 1000 early infant diagnostic tests were done.
“There has been an increase in the number of samples that are collected. The IST has supported the Viral Load scale-up program because we are now getting an increase in coverage within the districts. Because we are releasing results in a shorter period, there is increased confidence within the facilities, clinicians, and customers so now we are experiencing better outcomes in patients and the clinicians can manage to patients,” said Mr Makombe.
The UNDP-Global Fund partnership has been a cornerstone of Zimbabwe’s remarkable progress in the HIV response. Since 2003, the Global Fund has invested over US$2.3 billion and has newly approved a 3-year (2024-2026) US$436,970,984 HIV grant to Zimbabwe. The Global Fund support under the Grant Cycle 7 (GC 7) is a continuation of the NFM 3 (GC 6), which will contribute to the achievement of the vision and goals of the Zimbabwe National HIV and AIDS Strategic Plan (ZNASP) IV Addendum (2021-2026).
