Terry Marshall Program Head NHLS Comprehensive care Management

SA ANC Data 2006 1/10 South Africa's land surface. 21% of South Africans in

SA ANC Data 2006 : Provincial Distribution NDOH, SA 2006 PRAVI MOODLEY DEPT OF

SA ANC Data 2006 : Age Distribution NDOH, SA 2006 PRAVI MOODLEY DEPT OF

CD 4 ? Viral load PCR Viral Load ? CD-4 PRAVI MOODLEY DEPT OF

SA CCMTP NHLS EQA ØFlowcytometry CD-4( Beckman-Coulter, Becton-Dickinson) – NHLS QAD ( Glencross ,

SA National Data: infant diagnosis PCR per month Terry Marshall, CCMT Program NHLS (2007)

SA National Data: infant diagnosis PCR results Terry Marshall, CCMT Program NHLS (2007) PRAVI

KZN Data : DBS HIV DNA PCR PRAVI MOODLEY DEPT OF VIROLOGY

Implementation : DBS HIV DNAPCR KZN 2005 Age Distribution of Children Tested N =

Implementation : DBS HIV DNAPCR KZN 2005 Positive HIV DNA PCR in infants N=3454/16409

SA National Data: infant diagnosis PCR per Laboratory Terry Marshall, CCMT Program NHLS (2007)

Data Comparison : % contribution KZN vs SA National PCR test Volume KZN 21%

SA National Data: monitoring CD-4/ month Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY

SA National Data : monitoring CD-4 by Category Terry Marshall, CCMT Program NHLS (2007)

KZN Data : monitoring CD-4 Laboratories Jan– June 2008 PRAVI MOODLEY DEPT OF VIROLOGY

Data Comparison : % contribution KZN vs SA National CD-4 test Volume 23% of

SA National Data : monitoring viral load tests/month Terry Marshall, CCMT Program NHLS (2007)

SA National Data : monitoring Viral load volumes per laboratory Terry Marshall, CCMT Program

SA National Data : monitoring viral load by Category Terry Marshall, CCMT Program NHLS

Data Comparison: % contribution KZN vs National Viral Load test volume 21% of the

KZN Data Viral Load tests per Laboratory Jan – June 2008 PRAVI MOODLEY DEPT

SA National Data NHLS Laboratory Capacity Support for CCMTP HIV/AIDS, SA Number of Laboratories

Acknowledgements National Department of Health, South Africa. Kwa. Zulu-Natal Department of Health, South Africa.

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Terry Marshall: Program Head, NHLS: Comprehensive care, Management and Treatment Program (CCMTP) : HIV and AIDS, SA. Pravi Moodley : Clinical Virologist, NHLS, KZN, SA PRAVI MOODLEY DEPT OF VIROLOGY

SA ANC Data 2006 1/10 South Africa's land surface. 21% of South Africans in KZN NDOH, SA 2006 PRAVI MOODLEY DEPT OF VIROLOGY

SA ANC Data 2006 : Provincial Distribution NDOH, SA 2006 PRAVI MOODLEY DEPT OF VIROLOGY

SA ANC Data 2006 : Age Distribution NDOH, SA 2006 PRAVI MOODLEY DEPT OF VIROLOGY

CD 4 ? Viral load PCR Viral Load ? CD-4 PRAVI MOODLEY DEPT OF VIROLOGY

SA CCMTP NHLS EQA ØFlowcytometry CD-4( Beckman-Coulter, Becton-Dickinson) – NHLS QAD ( Glencross , NHLS) ØQuantitative HIV-1 Viral Load ( NASBA, Biomerieux) – QCMD, NEQAS ØQualitative DBS HIV-1 DNA ( PCR, Roche) – QCMD, CDC Infant diagnosis < 15 months ØPiloting National IQC program : Viral Load , possibly PCR if successful. Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data: infant diagnosis PCR per month Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data: infant diagnosis PCR results Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

KZN Data : DBS HIV DNA PCR PRAVI MOODLEY DEPT OF VIROLOGY

Implementation : DBS HIV DNAPCR KZN 2005 Age Distribution of Children Tested N = 16 409 SA AIDS, 2007 PRAVI MOODLEY DEPT OF VIROLOGY

Implementation : DBS HIV DNAPCR KZN 2005 Positive HIV DNA PCR in infants N=3454/16409 infants (21%) SA AIDS, 2007 PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data: infant diagnosis PCR per Laboratory Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

Data Comparison : % contribution KZN vs SA National PCR test Volume KZN 21% of SA population produces 31% of PCR tests Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data: monitoring CD-4/ month Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data : monitoring CD-4 by Category Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

KZN Data : monitoring CD-4 Laboratories Jan– June 2008 PRAVI MOODLEY DEPT OF VIROLOGY

Data Comparison : % contribution KZN vs SA National CD-4 test Volume 23% of CD-4 tests come from 21% of SA’s population Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data : monitoring viral load tests/month Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data : monitoring Viral load volumes per laboratory Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data : monitoring viral load by Category Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

Data Comparison: % contribution KZN vs National Viral Load test volume 21% of the country produces 30% of the viral load tests. Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

KZN Data Viral Load tests per Laboratory Jan – June 2008 PRAVI MOODLEY DEPT OF VIROLOGY

SA National Data NHLS Laboratory Capacity Support for CCMTP HIV/AIDS, SA Number of Laboratories Systems CD-4 Test Capacity Tests per %Test month utilization per month 56 78 351 000 250 000 71% 17 25 108 000 70 000 65% 8 9 35 100 16 500 47% NASBA Viral load HIV DNA PCR Terry Marshall, CCMT Program NHLS (2007) PRAVI MOODLEY DEPT OF VIROLOGY

Acknowledgements National Department of Health, South Africa. Kwa. Zulu-Natal Department of Health, South Africa. Global Fund AIDS TB Malaria (GFATM). Absolute Return for Kids (ARK), UK. Italian Co-operation, South Africa UNICEF, South Africa. BMS-Secure the Future. NHLS and our Staff All Our Patients PRAVI MOODLEY DEPT OF VIROLOGY