June 27th

            

Stephanie and I with some of our co-workers last Friday. The woman holding the flowers is my supervisor.

            I drew my first blood samples at the clinic last week. I’m a certified phlebotomist in the United States, and my supervisor at WE-ACTx happily allowed me to join our resident laboratory manager in blood collection. From Monday-Thursday, blood is drawn from patients to observe their CD4 levels and Viral Load. The lab tech usually takes samples from around 20 patients a day. This process begins around 9 am and concludes around 12 pm.

            An average of two tubes are drawn for each patient, and the lab tech writes the patient’s Track Net (identification) number and the desired test (CD4 or Viral Load) on each tube. He then completes a request form for every individual tube. This form contains patient information along with the requested test. The samples are then driven to the national laboratory for examination. The lab is a short 5-minute drive from the clinic. This procedure occurs each weekday, except for Friday.

            Fridays are reserved for providing HIV tests to family members of patients and anyone else who wants to be tested. We usually see 5-7 individuals for the examination on these days. The procedure consists of a series of two tests: Colloidal Gold and Determine. The lab tech first draws blood from all of the patients in a red top tube, which doesn’t contain any anticoagulants. This means that the blood will clot, leaving serum. This type of specimen is preferred when testing for diseases. He then labels each test with the patient’s Track Net number so that the results aren’t confused. A pipette is used to extract the serum and place a drop on the designated spot. A drop of sample diluent is placed on top of the blood in order to carry it up the test. The test may produce two results: a top line and a bottom line or only a top line. The top line is the control and the bottom line indicates that a virus is present. Below are the results from the five people we tested last Friday.

The lab tech adding the serum to the Colloidal Gold Test.

Results of Friday's Colloidal Gold Tests. All are positive as indicated by the bottom line.

            Since all of the tests came back positive, the lab tech moved to the second test; Determine. This test is more accurate than Colloidal Gold, which is being discontinued in July because of its high inaccuracy rate. The same procedure is followed for Determine, however, a drop of sample diluent is not necessary. The test is let sit for 15 minutes to 1 hour. The bottom line provides the results and the top line is the control. If a line is present, the patient is HIV positive. In this case, the lab tech fills out a form and circles Positive in red pen. If negative, he circles negative in blue pen. (The nurse who discloses the information insists that they are labeled by color.) If the results come back inconclusive, then the sample is sent to the national laboratory to undergo the ELSA test, which is the most accurate. Once the results have been determined, a nurse sits with each individual and shares his or her results. Steps are then taken by the clinic to assure that each person receives the proper care they need. Since all HIV treatment is free in Rwanda, this process mainly involves determining which clinic is most convenient for the new patient.

The lab tech adding serum to the Determine test.

Results of Friday's Determine test. All patients, except for the center, were HIV positive as indicated by the bottom line.

-E