Mobile HIV testing in South Africa

Mary-Ann and Angeline have been wondering all morning whether they should go to the public square to get tested for HIV. They are 19 and 21 years old and single. Both live in the town of Caledon, about 120 kilometres west of Capetown.

The state-run laboratory service is testing not just for HIV, but for tuberculosis (TB) as well. Nobody will find out whether the young women get tested for HIV, tuberculosis or both. "Are we going?" asks Mary-Ann. "We're going," replies her elder sister.

On Caledon's main street, dogs jump to the side of the road as a huge white truck drives into the square. Uwe Schön gives the driver parking instructions, but still cannot quite believe what is happening. "We've finally arrived at our destination," he says. "It's a red-letter day for our baby." Standing 4 meters tall, 5 meters long and 2.5 meters, his "baby" is a mobile biosafety laboratory.

Uwe Schön is a physicist at the Fraunhofer Institute for Biomedical Engineering (IBMT) in Sulzbach in the German state of Saarland. He has been working on this truck as lead engineer for the last five years.

Poverty prevents people from getting tested

40-year-old Suzette Pfeiffer rushes up to him. "Can you test blood with that thing right away," she asks. Uwe Schön nods. "That's great," the woman says, explaining that she works at an old people's home. Until now, she had to sent blood samples to Capetown whenever she wanted to determine the HIV status of one of her patients. But many samples got lost on the way and never arrived. Suzette Pfeiffer is therefore thrilled about the arrival of the mobile laboratory. "That's really great," she enthuses. "Welcome to the end of the world!"

Mobile laboratories can help fill a gap in patient care in Africa where distances are vast and difficult to cover. Poverty is often so extreme that people simply can't afford to be away for two days in order to take a HIV test. "It's a problem," says Professor Hagen von Briesen, who is head of AIDS projects at IBMT. "People are wasting time when they could have already started on therapy," he says. And so the idea of a mobile laboratory was born at IBMT in 2007, far away from Africa. It reduces the time needed for testing in remote areas down to a few hours.

HIV-AIDS still taboo in South African society

Inside the mobile laboratory, preparations are well underway for the testing of the first samples. Sam, the laboratory assistant, is making sure the internet connection is working and his colleague Byron has just entered the back of the vehicle through the airlock. This is where all the medical technology is to be found. The air that is used here passes through a filter in both directions so as to protect patients, staff and the environment. "Conditions here are perfect," says Byron, "just like in a clinic."

Mary-Ann and Angeline have had their blood taken and the droplets have been placed on separate test strips. Now they have to wait. "How long?," they ask. "Not long," says Janine Ross, a social worker who looks after hundreds of HIV patients in this remote area. "What frustrates me the most is that many people in South Africa still simply refuse to talk about HIV," she says. One of her clients is 24-year-old Edwina. She's been HIV positive for seven years. "My friend knows, he's also HIV-positive, but my mother hasn't the vaguest idea what has happened," she says. She swallows six tablets every morning and every evening as well. "I cope," she says, "and enjoy being in the company of other people again:"

Almost 20 percent of South Africa's population is HIV positive, one of the highest rates of infection in the world. In 1990, only one percent of pregnant mothers were carrying the virus, now that figure is 30 percent. It is a catastrophe, but also a story of human determination and resilience in the face of adversity. Just over thirty years ago two doctors in the United States described five cases of pneumonia in the weekly digest Morbidity and Mortality. They turned out to be the first reported victims of the AIDS epidemic.

"These days nobody has to die of AIDS, because the drugs work" says Professor Wolfgang Preiser, head of the Department of Medical Virology at Tygerberg Hospital in Cape Town. He says the next step must be to find a vaccine. And this is where the mobile laboratory could help save even more lives. It contains a cryobank in which the blood samples are frozen down to minus 195 Celsius. The information the samples contain is digitized. This technology was developed by the Fraunhofer Institute in Sulzbach. Most of the funding came from the Bill & Melinda Gates Foundation, whose projects include the search for an AIDS vaccine.

HIV and TB together can cause serious complications

Mary-Ann and Angeline have also had a sputum test. Sputum is matter coughed up and ejected from the mouth. Byron is examining it in the mobile laboratory. TB (tuberculosis) is not only highly infectious, it is also just as big a problem as HIV in this part of South Africa. "HIV can be treated," says Professor von Briesen, "but the combination of HIV and TB is more difficult to handle." Under such circumstances, he explains "getting a diagnosis early is especially important, and this is where this mobile laboratory will really demonstrate its usefulness."

Two hours later Mary-Ann and Angeline have an appointment with Janine, the social worker.

"I have your results," she says. The young women are visibly nervous. "No active tuberculosis, no infection with HIV. Look after yourselves", the social worker says. Janine is particularly impressed by the speed with which the mobile laboratory can deliver results, sparing the patients many anxious, nail-biting, hours of waiting.

Towards evening Uwe Schön parks the truck in the yard of the local hospital. A little later, baboons from the nearby forest decide to come and inspect the vehicle, from the inside.

"Is it possible to lock the laboratory door from the inside?" Byron asks. Uwe Schön shakes his head. "That's something we need to improve," says Byron, "baboons are very strong, they can open doors and they don't knock beforehand."