Access to appropriate diagnostics remains a barrier to providing effective HIV patient care and treatment in Cameroon. Some of the key challenges with the current system of conventional laboratory-based testing include:
a) Patient burden – Patients must return to the facility multiple times to receive test results. This places a high burden on patients, and it can adversely affect effective management of patients on treatment and delay in initiation of treatment and cause patient loss to follow-up.
b) Specimen referral – Because most health centers providing HIV care do not conduct POCT such as CD4 testing, most refer specimens to a conventional laboratory for testing. This often requires complex logistics and transport conditions may compromise specimen quality in addition to the usually long turn-around-times. If specimens can only be referred on certain days, this limits access to testing.
c) Staff requirements – Conventional technologies must be used by a highly skilled technician and require extensive training to run; this means they cannot be used in many facilities without highly trained staff, and staff re-locations are a major concern.
d) Cold chain – The transport of many reagents in the current system in Cameroon requires a cold chain; if this is not maintained, accuracy of results may be complicated. Additionally, maintaining the cold chain is difficult given infrastructure constraints.
e) Service and maintenance – A robust system for the provision of regular preventive and efficient curative maintenance services are crucial for uninterrupted functioning of standard laboratory testing equipment platforms. Underdeveloped capacity, lack of spare parts and logistic problems are currently posing immense challenges to Cameroon’s laboratory equipment maintenance program across all conventional testing instruments currently in use in the country. Introduction of cost-effective POC technologies with minimal or no maintenance needs and spare part requirements is one of the options to minimize the frequency of service interruptions due to failures and prolonged down- times of conventional testing systems. As such, consideration of POC technologies for CD4 testing, RDT, viral load, EID, and others tests is of particular importance as this parameter provides critical information for the proper management of patients on treatment and prompt initiation of therapy for those who are in need. For instance, introducing POCT diagnostics can expand access to critical CD4 testing, allow patients to receive results on-site the same day they are tested, and it can reduce the logistical challenges of specimen transportation.