Some supply chain heroes wear lab coats In Zimbabwe, two resourceful laboratory technicians ensure access to viral load testing for people living with HIV/AIDS

Plumtree District Hospital, near Zimbabwe's border with Botswana, has an HIV/AIDS clinic that serves 4,000 patients within the region.

Kasilaye Sibanda is one of those patients. In November 2019 he received a shot of antibiotics to treat opportunistic infections related to HIV. Nearby Marula Clinic referred him to Plumtree District Hospital, as clinic staff were struggling to keep him well. He also had his blood drawn at the hospital to test his viral load levels, which were expected to be unacceptably high. Once his health improves, Kasilaye will be eligible to switch to TLD, the new and preferred HIV treatment regimen.

Staff supporting HIV/AIDS programming at Plumtree.

Patients like Kasilaye have a dedicated team of health professionals at Plumtree, including laboratory staff, working to keep him healthy.

Because of the hospital's location, many of its patients work abroad year-round in neighboring Botswana, Namibia and South Africa. For the 4,000 patients living with HIV/AIDS served by Plumtree, medical visits should be every six months, but some patients visit the hospital only annually or every two years, often during the Christmas and New Year's holidays. For those patients, the hospital arranges to get their antiretroviral medicines to them through family members or representatives of community refill groups.

Despite many challenges, 12.5 percent of the hospital's patients are transitioning to TLD each month as required by the Ministry of Health and Child Care. HIV viral load testing, however, can only be done when patients pay a visit. The laboratory has faced additional challenges since the country's power supply has been unreliable the past several months.

Ranganai Mabuda is a laboratory technician at the hospital. For viral load tests, he operates four machines that require electrical power like the one in the photo here.

As with most other health facilities in Zimbabwe, Plumtree Hospital has experienced cuts in power for more than six months. The hospital has a solar array that no longer works. During power cuts, a backup generator provides electricity, but only when hospital staff can get fuel, which is constantly in short supply and quite expensive.

On a good day, the lab can run from six to 20 viral load tests. But at times the lab can go for up to two days with no electrical power at all.

Felistas Malaba, principal lab scientist at the hospital, is the other driving force behind the hospital's viral load program. She and Ranganai are very resourceful, employing several strategies to ensure viral testing keeps pace with demand.

They maintain a backup battery that typically lasts long enough to complete tests that are in progress when the electricity fails. As a result, they manage to only waste five percent of the cartridges needed to run the viral load tests.

To maintain the quality of blood serum from patients, they constantly freeze ice when electrical current is flowing, and then move it up to refrigerators to keep serum cold during power cuts. While this strategy is effective, it requires constant monitoring by staff.

Because of the high mobility of most of their patients, they often send test results via WhatsApp. Felistas and Ranganai are proud that, because of their creativity and hard work, most patients are getting their viral load test results.

A laboratory is at the end of a long and complicated supply chain of equipment and supplies required to support HIV/AIDS programs. Remarkably, thanks in large part to the creativity and dedication by the laboratory staff, test results are available to show that 85 percent of the Plumtree District Hospital's HIV/AIDS patients have suppressed levels of viral load.

All photos by Tafadzwa Ufumeli

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