NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Monday, December 29, 2014

When John Barber, a project manager at Daktari Diagnostics, sought to test his company’s instrument, he went to the type of place where the technology might have the most impact: a small fishing village on the shores of Lake Victoria in Uganda. He awoke at dawn on a November morning in 2013, tossed a few Daktari devices into a backpack, and, together with a team of HIV-treatment specialists, drove 2 hours to the village of Kasensero, where the first Ugandan case of HIV was reported more than 30 years ago. Driving a Jeep along dirt roads with more cows than traffic, “we were off the grid,” Barber recalls.

Barber and his team showed up at 8 a.m. and found about 20 people already waiting for them. Dozens more arrived within the hour. An estimated 43 percent of people in Kasensero are HIV-positive, and these patients wanted to know whether the virus had started to damage their immune systems. The medical team was there to check the patients’ CD4 counts, a measure of immune cells that indicates how well the body can stave off opportunistic infections such as tuberculosis. Based on test results, some people would need to start antiretroviral therapy. Others might need their medications adjusted.

The villagers didn’t get answers that day. While the Daktari device is capable of providing same-day results, it was only being tested during Barber’s visit to Uganda. So the Kasensero patients had to settle for the standard CD4 diagnostic procedure: testing on a large and expensive desktop instrument called a flow cytometer, which requires dedicated laboratories, highly trained technicians, and infrastructure for shipping refrigerated reagents long distances. Because the nearest flow cytometer was in a town 80 kilometers away, the HIV-treatment team had to collect and transport vials of blood for testing and couldn’t inform villagers of their CD4 levels until they returned for their next scheduled visit months later. At worst, patients were lost to follow-up. At best, critical medical decisions got delayed. Either way, the virus became tougher to fight.