Major HIV fight equipment due
Plans in train to set up national public health laboratory By Samantha Alleyne
Stabroek News
April 25, 2004

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A much-needed piece of equipment to boost the HIV and AIDS fight is expected in the country soon and it will be housed in the Georgetown Public Hospital Corporation laboratory.

Minister of Health, Dr Leslie Ramsammy has an-nounced that a CD4 T-cell count machine will arrive here soon which is being funded by the Atlanta, USA- based Centers for Disease Control and Prevention (CDCP).

During a recent interview with Stabroek News, the minister said the plan was to set up a special laboratory for all HIV testing, which would have been the precursor to Guyana's first national public health laboratory. However, it was taking too long and the minister said he had pointed out to CDCP that the money they would spend to refurbish the area on top of the mortuary building at the hospital could be used to build a brand new building.

"I said to them, why don't we build the new building? That way I could start my public health lab now rather than wait for a long time. Whilst they are building it, instead of dallying with testing, the HIV/AIDS equipment will be located in the present laboratory, and they have agreed to it."

The CD4 T-cells are immune cells that dwindle as AIDS develops. The test measures the immune status of an individual, rather than HIV. However, according to Dr Ramsammy it is relevant to HIV because the virus destroys the CD4 T-cells. The CD4 T-cell count test helps to determine when persons should be placed on HIV treatment, instead of waiting until they start to show signs, as is currently the case in Guyana.

The minister said CDCP has committed also to providing equipment for viral load and HIV P24 antigen testing, a relatively inexpensive test, developed by Dr Jorg Schupbach of the University of Zurich, Switzerland.

He said the introduction of viral load testing was important since it detects the virus itself. According to the minister, while it will be useful to know soon after that a person is positive, the viral load test is more useful. The P24 antigen test, he said, also gives a faster more reliable result, since it checks for a particular protein found in the virus. So once the protein is present then the virus is there.

"Our concern is the children; we want to know what's happening with the children." Children born to HIV positive women could inherit their mothers' antibodies and therefore test positive, but this does not mean that the child is infected, he said.

"Only about 35% of the babies born to HIV positive women are really infected. The other 65% are not infected even though their mothers are," he noted. "So you have a dilemma with these babies since we don't know whether we should start managing them for HIV or whether we should wait."

The minister said that they would not want to give all of them drugs over a long period of time as the drugs are not mild ones. Therefore, the test to know if the baby is positive right away is the P24 antigen test, since it takes up to 18 months until the child will be free of the antibodies, and in some cases the baby dies before it reaches 18 months if it really is infected. "If we know from day one, we can move that baby into the programme. But right now we have to guess. Guyana will be one of the first countries in the region to have the P24 testing."

Speaking on the Global Fund, the minister said the fund took a long time to appoint its local funding agency. However, it has done so in the name of Deloitte & Touche, an accounting auditing firm, which also represents the Global Fund in other countries. The firm will be responsible for the administrative work locally, verifying a number of pre-requisites for Guyana before disbursement commences.

According to the minister, Guyana had to show that it had the capacity to spend the money. But he disclosed that the identical set of requirements was also required by the World Bank, which had technical people working in Guyana doing all the evaluation. As such, the Global Fund has decided to use the same evaluation done by the World Bank to give Guyana the funding.

Guyana had submitted two proposals to the fund and was awarded US$31.9 million for both, $29 million for HIV and $2.9 million for malaria. The first disbursement will be $9 million for the first two years and after that it will be on a year-to-year basis.

The money will see an expanded awareness and education programme, expanded treatment and care program-me, more Voluntary Coun-selling and Testing (VCT) sites and more support for non-governmental organisations.