Rachel Gerver

Rachel5th year Bioengineering PhD student,

Joint program UC Berkeley – UCSF

Nyanza Province, July 2014

 

As an engineer, I participated in the FACES-STEP program to better understand how new technologies could help address unmet healthcare needs.   I’m a PhD student in the Herr lab at UC Berkeley where we develop new tools to analyze biological systems, including microfluidics for rapid protein detection in patient samples.   I applied for and received a DIL/USAID Explore research grant to travel to Kenya to investigate the potential of applying our lab’s technology to a point-of-care rapid test for early infant HIV diagnosis.

During my time in Kenya, I had the opportunity to visit a number of FACES clinics and meet with doctors, nurses, lab technicians & managers, HIV test counselors, and other stakeholders.   I was impressed by the dedication and passion of health care workers to stem the spread of HIV and with the systems in place to monitor patients and ensure high quality assurance in diagnostic testing.   I saw the power of new technologies, particularly HIV rapid tests, to dramatically improve the diagnosis and treatment of HIV, improving the health of individuals and whole communities.  I also saw the frustration when current processes and tools cannot fully meet the healthcare needs of a community.

Adult HIV rapid tests are not effective for early infant HIV diagnosis due to the presence of maternal antibodies that can persist for up to 18 months.  Instead, dried blood spots are taken at 6 weeks and then sent to a central testing lab for diagnosis via DNA PCR.  Unfortunately, under the current system, early infant diagnostic test results can take 3-4 weeks or longer, delaying the start of treatment with combined antiretroviral therapies and creating additional stress for mothers.   I was surprised to learn through the course of interviews that the primary driver of the long test delays in early infant HIV diagnosis may not be the use of a single central testing lab or challenges with sample transport to that lab, but rather the frequent stock outs of test reagents at the central lab, which can lead to backlogs of patient samples.

I came away with an increased appreciation of the importance of understanding the surrounding infrastructure within which a new technology will be utilized.   New point-of-care diagnostic technologies can only be effective if the underlying logistics and supply chain issues are also resolved and simply ensuring adequate test reagents at the central labs would likely result in a significant decrease in time to test result, even in the absence of new diagnostic technologies.  My experience has only increased my interest in applying my skills to addressing pressing global health needs and in better understanding the surrounding systems to ensure that new technologies are designed appropriately and deployed in a way that can have a positive impact on local health.

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