1. Case Brief Yorgos Marinakis
Balancing Access with Accuracy for Infant HIV Diagnostics in Tanzania (A)
Case Brief
Yorgos Marinakis

2. Case Brief
There was a gap between the existing market for sophisticated laboratory-based diagnostics in wealthy nations, and the need for point-of-care diagnostics to serve areas that could not support lab-based diagnostics.
Palamountain received $4.9m from the Gates Foundation to found the Global Health Initiative (GHI), which quickly narrowed its focus to developing affordable point-of-care HIV diagnostics for underserved nations in resource-limited settings.
One of GHI’s projects covered infant diagnostics in Tanzania.

3. Case Brief (cont.)
Infant diagnostics were important due to the benefits of early detection and treatment.
Tanzania had the world’s third-highest number of children under 15 infected with HIV.
Limited infrastructure (water and electricity) and medical personnel required a tradeoff:
Provide advanced care to the minority of the population that could access it, or
provide minimal care to those with poor access.
Same tradeoff for infant testing:
Inexpensive, rapid, easy-to-use infant diagnostics in use tended to show false positives, because they analyzed antibodies, and infants retained maternal antibodies for up to 18 months age.
More accurate tests required large expensive complex laboratory equipment, and trained personnel.

4. Case Brief (cont.)
The GHI developed three mutually exclusive technology options:
Strip test
Squeeze test
Filter paper test
Information on the technologies were presented to Tanzanian government and healthcare provider representatives, and open- ended feedback was solicited.
Photos, procedures, timing, cost, accuracy.
Accuracy:
Sensitivity: % of persons who had the condition who were correctly identified are having the condition.
Specificity: % of persons who did not have the condition who were correctly identified as not having the condition.

5. Case Brief (cont.)
In February 2004, U.S. launched President’s Emergency Plan for AIDS Relief (PEPFAR), with $15b in international funding for AIDS diagnosis and treatment.

6. Videos
UNICEF: Child survival through early infant HIV diagnosis (
Early Infant Diagnosis (EID) - CHAI and HP Partnership (