Country Background
Namibia has one of the highest HIV/AIDS prevalence rates (the percent of people living with the disease) at 20% in the world, a much higher rate than 7.5%, the rate of the sub-Saharan African region overall. The HIV prevalence rates in women and people ages 25- 29 are even higher, presenting significant needs and challenges for infant diagnosis.  On the other hand, Namibia has a relatively more advanced healthcare delivery system than many other African countries, and domestic funding and PEPFAR funding are available and dedicated for HIV/AIDS programs.  DNA PCR Dry Blood Test was rolled out in 2006 and is currently used for infant diagnosis.

  GHI in Namibia

GHI in Namibia
In 2008, GHI teams conducted a field research study on HIV/AIDS treatment and infant diagnosis in Namibia.  With focus on an infant testing devices market study, the GHI Kellogg team met with health care facilities and providers, and interviewed with key opinion leaders in Namibia.   The GHI team investigated the current infant diagnosis status, the infant testing techniques available, and constraints of the existing program in Namibia.  The team also analyzed the market size and growth for infant diagnosis in Namibia, studied the barriers of entry, and identified the potential collaborators.  The roles of the major stakeholders for HIV/AID diagnosis were studied and their interest in the GHI point of care infant diagnosis was gauged. 

GHI future work in Namibia
GHI will continue to build relationships with the key stakeholders in Namibia and work with international partners on HIV/AIDS and infant diagnosis.  Future GHI actions in Namibia will include: partnership and collaboration formation, introduction of new testing techniques and devices, identification of locations for infant diagnosis pilot program, and construction and execution of a pilot program.

Preliminary Findings from Namibia
In 2008, students of the GHI visited various parts of Namibia and Botswana to conduct research.  In 2006, both countries introduced DNA PCR dried blood spot (DBS) testing for infants where blood samples are collected at remote testing sites and are sent to central laboratories for testing.  These testing networks now reach the majority of HIV exposed infants in Namibia.

GHI’s proposal for a POC infant diagnostic device was met with moderate enthusiasm in both countries.  Recognized benefits included improved turnaround time of anywhere from 4-8 weeks (on average), accelerated treatment, and a probable reduction in long-term costs.  However, these benefits were deemed as less impactful than benefits that could be realized through investment in other problem areas (i.e. malaria, tuberculosis, education and infrastructure). Furthermore, the increasing effectiveness of the PMTCT program (Prevention of Mother to Child Transmission) will make the need for short turnaround time less pronounced. 

Among those who work directly with mothers and infants, there were varying levels of excitement regarding the proposed devices. In Namibia, the DBS tests are administered through a private government-affiliated organization, the Namibia Institute of Pathology (NIP).  NIP does an exemplary job of keeping turnaround times at 2 weeks or less, although there is additional lead-time in getting the results to mothers.

In conclusion, this group found that the POC infant test would be less impactful in Namibia and Botswana than in countries where no DNA PCR testing is available.  However, the countries’ developed infrastructure suggests that a pilot test would be an implementation “best case scenario,” and this could be a positive for a pilot.  Key recommendations from this group are:

  1. Maintain regular contact with the stakeholders they met
  2. Work with international partners across countries
  3. Identify the best pilot site/county for the POC testing device