Hi Nick, thank you very much for your thoughtful feedback! I researched the syphilis idea so will address those questions.
1. The dual tests have recently become very cheap too, costing some $0.95 each (largely thanks to CHAI’s work in this area). In our understanding, this is only some $0.15 more expensive than a single HIV test – though I’m sure prices will vary geographically. If there are places where the dual tests are more expensive than two separate rapid tests, then I agree that the dual tests wouldn’t make sense there.
2. You are right that changing the existing system (including updating diagnostic algorithms and training the relevant health workers) is one of the main challenges and one of the reasons why this idea has not already been implemented more widely. However, it seems that what is currently lacking is technical assistance for countries’ health systems to make this switch – and this is exactly the sort of implementational work that we think strong charity entrepreneurs can do well!
Thanks on point 1 that makes sense. To add (I should have said before) that often HIV tests will already be supplied through a different donor program and the easies thing might just be to add, so yes being very aware of those dynamics is importnt
On point 2 I don’t think changing the system will necessarl be all that hard in many cases. It is likely to be be more of a financial/logistics issue getting the tests to the health centers than a technical/education problem. If the tests are freely available at facilities people will do them. Most health providers already know women should get a syphilis test even if it’s not available at this point in time. Both staff and patients often love the idea of extra tests in Uganda at least (which might see weird to some people) so I doubt the barriers will be that great. 100% agree that a strong charity entrepreneur could pull this off well.
Hi Nick, thank you very much for your thoughtful feedback! I researched the syphilis idea so will address those questions.
1. The dual tests have recently become very cheap too, costing some $0.95 each (largely thanks to CHAI’s work in this area). In our understanding, this is only some $0.15 more expensive than a single HIV test – though I’m sure prices will vary geographically. If there are places where the dual tests are more expensive than two separate rapid tests, then I agree that the dual tests wouldn’t make sense there.
2. You are right that changing the existing system (including updating diagnostic algorithms and training the relevant health workers) is one of the main challenges and one of the reasons why this idea has not already been implemented more widely. However, it seems that what is currently lacking is technical assistance for countries’ health systems to make this switch – and this is exactly the sort of implementational work that we think strong charity entrepreneurs can do well!
Thanks on point 1 that makes sense. To add (I should have said before) that often HIV tests will already be supplied through a different donor program and the easies thing might just be to add, so yes being very aware of those dynamics is importnt
On point 2 I don’t think changing the system will necessarl be all that hard in many cases. It is likely to be be more of a financial/logistics issue getting the tests to the health centers than a technical/education problem. If the tests are freely available at facilities people will do them. Most health providers already know women should get a syphilis test even if it’s not available at this point in time. Both staff and patients often love the idea of extra tests in Uganda at least (which might see weird to some people) so I doubt the barriers will be that great. 100% agree that a strong charity entrepreneur could pull this off well.