Our immune systems are comprised of various types of cells including CD4 cells, which are a type of white blood cell that moves throughout the body, helping to identify and destroy harmful bacteria and viruses. Along with other tests, a CD4 count helps to indicate the strength of our immune system and for people with HIV, the stage of infection. According to new WHO guidelines, a person with HIV becomes eligible to begin life-saving antiretroviral treatment when his/her CD4 count falls below 500. (Currently, Malawi is using a CD4 threshold of 350 for diagnosis.)
Technology for measuring CD4 levels remains expensive and sometimes prohibitive in resource-limited countries with struggling health systems and competing health care priorities. With financial support from USAID, Dignitas recently procured a “BD FACSCount” CD4 machine for Mulanje District Hospital in Malawi. Eight lab technicians at the hospital were also trained and began using the CD4 machine two weeks ago. By analyzing CD4 counts, the machine will help determine the stage of HIV infection for patients. Valued at approximately $48,000 USD, the machine will also assist clinicians in determining when HIV+ patients, including children, should begin antiretroviral treatment.
Previously, Mulanje was the only district in Malawi’s South East Zone without an efficient and reliable CD4 machine. The hospital’s old machine could only process 150 tests per month and had been malfunctioning on a regular basis. According to Dignitas’s Zonal Lab Service Coordinator Chimwemwe Basalankhunda, “The new machine is the only one of its kind that can process samples at room temperature. Other CD4 machines rely heavily on samples being stored at cooler temperatures before being analyzed.” With Malawi’s sub-tropical climate, it was not uncommon for blood samples transported from rural health centres to heat up, rendering analysis impossible. “It is expected that the new machine will raise the total number of patients tested per month to 500,” says Chimwewe.
Furthermore, with close to 13,000 pre-ART patients (those not yet eligible for treatment) living in Mulanje district, it is expected that patients will be started on ART much earlier than before because of access to efficient and reliable CD4 testing. With the new machine, same day test results for urgent cases are even possible. The expected result is that HIV morbidity and mortality rates in the district will be markedly reduced.