Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
Mail & Guardian Online - January 27, 2008
Belinda Beresford
Developed at Toga Laboratories in Johannesburg, the Togatainers combine a highly versatile South African resource -- the unwanted shipping container -- with laboratory machinery and satellite telecommunications.
Des Martin, a founder member of the Southern African HIV Clinicians' Society, and his colleagues developed the Togatainer. Other laboratories in a box include mobile chest X-ray clinics to screen for tuberculosis.Refurbished, with a self-contained power supply, and kitted inside with everything a lab technician could potentially desire, the Togatainer can go anywhere a large truck can travel. Ten Togatainers are in action so far, including some where the lab-in-a-box concept has been adapted to being a lab in a building.
Most of the time simple tests can be done on blood, saliva or even urine to find out whether someone is HIV-positive. But more comprehensive tests are necessary to measure how the disease develops and to check the success or failure of antiretroviral (ARV) treatment. The latter is crucial for patients whose lives depend on their doctors knowing whether the ARV drugs are working or are causing side effects, or even whether the patient is taking them properly. Such knowledge can help to reduce the spread of the drug-resistant virus.
A high level of adherence to ARVs is necessary for successful long-term suppression of HIV. A less diligent intake of pills could result in patients developing drug-resistant forms of the virus. Patients who are less than 70% adherent to their drug regimes are not such a public health risk. At this level they will get little benefit from the medicines and are likely to die fairly swiftly. In these instances the "drug pressure" exerted by ARVs is not sufficient to force the virus to mutate and the person does not become resistant (and gets no benefit from the drugs). People who are more diligent -- but don't adhere perfectly to their treatment -- will obtain some benefit and will survive longer but with increasingly drug-resistant forms of the virus. Although treatment failure in any patient needs to be detected as soon as possible to save lives, it is the second, not quite adherent, group of patients that is particularly important from a drug-resistant point of view.
Patients have to wait for their blood to be taken, the sample sent to a laboratory, the results sent back from the laboratory and placed in the correct patient's file. This lengthy procedure leaves ample room for mistakes and mishaps and makes it slow and ineffective. This is especially true for patients in rural areas for whom the costs of attending a clinic can be relatively high. Generators are built into Togatainers to ensure work can continue when power supplies fail. Each laboratory comes with a lab technician who is trained in Johannesburg. Information is fed back to the Toga Laboratories base in Johannesburg where the system flags any untoward results to alert the lab technicians.
By decentralising the testing and centralising the information processing, the Togatainer system manages to overcome the lack of high-level laboratory human resources.
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