April 26, 2020
HURUNGWE, ZIMBABWE — Pedzisayi Garanonga sits with her sister on their veranda, sipping a cup of tea to ward off the morning chill. They chat and laugh their sorrows away.
Garanonga, 42, has lived with HIV since 2009. In the past three months, persistent headaches and bouts of flu have made her worry that her medication isn’t working.
She should take what’s called a viral load test, which would reveal whether she needs a new treatment regimen. Yet Garanonga won’t go in for the test. When she took one in 2018, her blood sample went bad, likely because it took too long for a facility to test it. So, she never got her results.
“I am supposed to go back again to have another test done,” she says, “but I am not sure if the results will come.”
Garanonga’s experience is common in Zimbabwe, where 1.3 million people live with HIV. The nation has one of the highest HIV prevalence rates in sub-Saharan Africa.
In Zimbabwe, 88% of those with HIV are on antiretroviral treatment and should take viral load tests regularly. Instead, a tangle of problems with the testing has added to Zimbabwe’s HIV crisis, as patients must contend with a fractured health care system, lack of testing centers in rural areas and slow turnaround times for results.
A viral load test measures HIV particles per milliliter of blood. A low viral load means the patient’s treatment is working. A high load suggests that it isn’t. In that case, the patient must change treatments.
The scarcity of testing centers means many patients never learn their viral load. And delays in results mean patients like Garanonga may live for months with constant pain and uncertainty.
And with the arrival of the coronavirus in Zimbabwe, people with compromised immune systems are likely to be more concerned about their health. As of April 25, Zimbabwe had 29 confirmed cases of COVID-19, the disease caused by the coronavirus, but neighboring South Africa had more than 4,300.
“I have heard that coronavirus affects more people with diseases like HIV, hypertension, diabetes, among others,” says Charity Nyamutowa, who has both HIV and hypertension. “So I fear to even move around because the virus is deadly.”
Owen Mugurungi, who runs the AIDS and tuberculosis unit at the Ministry of Health and Child Care, acknowledges the problems with viral load testing. He says delayed test results mean delayed treatment decisions.
“The doctor, instead of making a decision within a week, the decision might be made after a few more weeks,” he says.
In Karoi, 204 kilometers (127 miles) from Harare, Zimbabwe’s capital city, the Karoi District Hospital does not have machines for viral load testing, so blood samples are sent to larger facilities.
Frankson Masiye, the acting district medical officer who also oversees the Karoi District Hospital, says that first his facility gathers samples from 38 clinics in the region. They sit between 30 and 150 kilometers (18 and 93 miles) away, he says, and fuel shortages have made efficient transport a challenge. So the hospital sends motorcycle couriers to collect samples.
Masiye says his hospital sorts and packages the samples, but some are rejected because they are too small (less than 5 milliliters) or because they don’t arrive in less than 48 hours. (After two days, blood samples go bad.)
Even after the samples reach the better-equipped hospitals, he says, electricity shortages sometimes push back testing.
“This leads to health deterioration of the patient as they await results,” says Masiye.
As Garanonga and her sister sit facing a guava tree in their yard, she says her poor health has kept her from working.
“I have a child who should be in grade four, but I am unable to work for money to take her to school,” Garanonga says. “I used to do part-time work in people’s homes, but I can’t anymore because of my health.”
Nyamutowa, 53, took her first viral load test in 2016, and because her load was high, she was moved to a new regimen of antiretroviral drugs.
Nyamutowa takes care of five children, and three are still of school age. She says she is a vendor, but can’t go to her stall sometimes because her legs are swollen.
She went back for another viral load test in May 2019. She is still awaiting the results.
“Maybe if my results came,” she says, “I would have had my medication changed, because maybe the medication is not working.”
The Zimbabwe National Network for People Living with HIV (ZNNP+) conducted a study in 2018-19 on HIV testing, treatment and viral load, focused on Harare and neighboring province Mashonaland East.
Clarence Mademutsa, the head of programs and training for ZNNP+, says that, among other things, the study found that patients far from public centers – where viral load tests are free – must sometimes turn to private facilities. There, a test may cost up to 2,000 Zimbabwean dollars (ZWL) ($80).
Overall, Mademutsa says, at a national level, Zimbabwe’s testing challenges are one reason it hasn’t reached a key target for epidemic control. Mademutsa says that viral load testing coverage stands at 51%, well below the 90% target for viral load results.
Mugurungi says if the government had the funds, it would move viral load testing to district hospitals and clinics, which are closer to more Zimbabweans.
Likewise, he endorses point-of-care testing. Patients could then check their viral load in a variety of locations, including pharmacies, clinics and at home. Most importantly, he adds, they would get their results in minutes.
Gamuchirai Masiyiwa, GPJ, translated some interviews from Shona.
Correction: An earlier version of this story included an image that was incorrectly published. Global Press Journal regrets this error.