On the top floor of the Maputo Central Hospital is the most modern laboratory of any public health service in Africa.
This is the molecular biology laboratory that analyses samples of blood from HIV-positive patients in order to determine when they should begin treatment with the life-saving anti- retroviral drugs.
The laboratory has been funded by an Italian Roman Catholic NGO, the Sant'Egidio Community, and is part of the community's DREAM programme - DREAM standing for Drug Resource Enhancement against AIDS and Malnutrition.
A second DREAM laboratory is now installed in the central port city of Beira, and within a month a third should begin operations in the northern city of Nampula.
The Italian laboratory coordinator, Dr Mario Calgaro, told AIM "This type of laboratory is new to Africa". The Mozambican public health system is the first on the continent to be equipped with this machinery - although Calgaro suspected that some private clinics in South Africa might have similar labs.
Some 15-20 health centres send samples to this laboratory for testing. Calgaro says the lab handles 1,700 patients a month, with more than one sample from some patients.
The equipment here allows the staff to count the CD4 cells - these are the cells in the human immune system that are attacked by HIV. The normal guideline from the World Health Organisation (WHO) is that when the CD4 count drops to 200 cells per microlitre of blood, it is time to start anti-retroviral treatment.
The equipment at this laboratory, Calgaro says, is the most sophisticated currently available for doing the CD4 count. It can also detect if there is anything else wrong with the patient's blood. It does a haemoglobin count, which can detect if a patient is in urgent need of a blood transfusion - in such cases the originating health centre is informed at once.
But the laboratory can look below the cell level: its equipment can also count the patients' viral load - that is, how much HIV they have in their blood. The anti-retroviral drugs work by reducing the viral load, sometimes to vanishingly small levels - though mo drug has yet been found that can destroy HIV altogether.
Once treatment has begun, follow-up samples are sent to the laboratory, which can determine the effectiveness of the drug through increased CD4 cell counts, and reduced viral loads. In principle, these tests can also detect whether there is any viral resistance to the drugs.
It is the tests at this laboratory that give the DREAM programme its confidence that drug treatment for HIV-positive pregnant women is preventing their babies from being born with the disease. The children's blood is tested at birth, and at three months, and six months old.
The negative results from these tests allow the programme to claim that 97 per cent of the babies born to the women it is treating are free of HIV.
Temperature control is crucial. Viral samples are kept at a temperature of minus 80 degrees centigrade. To minimise the chances of anything going wrong, each piece of equipment has its own power stabiliser, and the whole laboratory has its own generator, thus eliminating dependence on the occasionally erratic Maputo electricity supply.
When AIM visited, Calgaro was the only Italian in sight. He stressed that "Sant'Egidio does not want to stay here forever".
Instead, it wanted to train up Mozambicans to handle the equipment: and those Mozambicans would then be in charge of further training.
Currently the laboratory team consists of two biologists and five laboratory technicians, all of them Mozambicans, and two Malawian biologists undergoing training.
Calgaro says that Sant'Egidio pays the staff - but using the Ministry of Health wage scale. The wages are thus lower than a skilled molecular biologist might expect to earn in the private sector. Was Calgaro not afraid that, once they had gained sufficient confidence and experience, the laboratory staff might desert the public health service for more lucrative employment elsewhere ?
"It has never happened that people on Sant'Egidio projects go off to work elsewhere", he replied. "The people who work with us are motivated because of the challenge of AIDS. They want to study, and to continue this work. This is an investment for the future of Mozambique".
The cost of setting up this laboratory is about 350,000 US dollars, provided by Sant'Egidio, which raised money in Europe, notably from an Italian bank, Unicredito. The reagents used are now supplied by the Health Ministry.
Calgaro says that funding for the laboratory is guaranteed for at least five years. He, and the other Sant'Egidio members AIM has spoken to, do not imagine that funding will be a problem. Apart from tapping the generosity of the Italian public, Sant'Egidio is negotiating with institutions, including the World Bank.
The greatest advertisement for the programme is its success.
DREAM has been treating AIDS patients since March 2002 - and claims that 95 per cent of its patients are not only alive, but now enjoy a decent quality of life. Without the anti-retroviral therapy, most of them would be dead or dying.
Fonte: AIM
