There were 36 million people living with HIV/AIDS globally at the end of 2000. 70% of the adults and 80% of the children living with HIV in the world that year were in sub-Saharan Africa.

By far, the majority of these patients fell in the most economically productive age bracket of 15-49. Fresh out of medical school, as young healthcare professionals, we found ourselves on the sharp end of this challenge. The epidemic was rampant, and our resources were scarce.

At the local hospital, we would gather for ward rounds, and due to the high number of patients with end-stage AIDS, our professors would typically declare that they would only review the two or three non-AIDS patients with us — because there was not much to be done for AIDS. Care of AIDS patients was thus left to nurses and junior doctors.

As a result, young doctors like myself had to manage many patients with end-stage AIDS who had essentially come to the hospital prepared to die. It was a gut-wrenching experience that would forever shape my perspective on healthcare and indeed my career choices.

The most significant challenge was the process of diagnosis. Patients needed to undergo mandatory and lengthy pre and post-test counselling.

Further, there was no outpatient testing. It all had to be done in a hospital setting. This was a formidable barrier to testing due to the paucity of trained counsellors — often just the hospital matron in a 400-bed facility.

The diagnostic tests available then were complex and time-consuming, often leaving patients waiting a week or more for their results.

This was a cruel extension of the uncertainty they already faced. To make matters worse, post-test counselling of patients with positive results was very much akin to handing over a death sentence. There simply was no treatment option.

There was also widespread stigma that surrounded HIV/AIDS. I knew surgeons who would flatly refuse to operate on a patient if they had clinical AIDS or lacked a negative HIV test result.

Sadly, in the community, it was often the case that people avoided shaking hands or even sharing utensils with relatives or individuals who had clinical AIDS.

Given the absence of scientific information, communities crafted their own explanations for clinical AIDS. In my community, they referred to it as “Chira,” a term that essentially means “Curse” in the Luo language.

People believed someone in the afflicted’s lineage had committed a grave transgression against traditional practices, leading to the curse and their inevitable death.

The circumstances prompted me to set up one of the first HIV Comprehensive Care Clinics in government service before the advent of life-saving Antiretroviral medicines (ARVs). I decided to affectionately call it “The Family Clinic”.

We based The Family Clinic at the Kilifi District Hospital – then a very remote facility on the coast of Kenya — with a little shining beacon of hope that was the Kemri-Wellcome Trust Malaria Research Facility where I was primarily employed.

My employer donated my time and a modest pharmacy of drugs to treat opportunistic infections. I was thus able to run this HIV clinic one day every week. Simple as it was, that was one of the best things I have ever done in my career.

Much of my time was spent talking to patients who commonly faced depression following their diagnosis.

Most patients came in not understanding the gravity of their diagnosis – many were hearing the term ‘HIV/AIDS’ for the first time. I had to explain their condition to them over several sessions.

My heart always fluttered as I watched any hope they had turn into deep despair when they realised they only had a short time left to live. I remember one young lady, though. Her name was MC, a local woman of about 27 years old.

MC was different. She had five children, could not recall any of their fathers and sold moonshine for a living, often arriving at the clinic under the influence of alcohol, giddy and quite optimistic — the kind of patient one never forgets! Despite her diagnosis and circumstances, she always remained optimistic and happy, and I remember laughing a lot with her.

I guided her to cut down on her alcohol use and advised her to focus on her children and her overall health. Over time, we became close friends. It was surprising that she never succumbed to depression despite understanding the gravity of her diagnosis.

As my patient count rose to around 300, many of whom died, having progressed to clinical AIDS because there was no treatment available, I began to rethink my career. At this stage, ARVs were available in the West but were astronomically expensive and far beyond our reach. I wanted to direct my career to where it would count for millions of patients like MC across Africa.

Eventually, I left for London to further my studies and then went on to build a career in the pharmaceutical industry. A decade after I had left, I was invited back to the Kemri-Wellcome Trust Research Unit for an anniversary celebration.

When I returned, the Family Clinic, which was once a single, dilapidated room next to the TB clinic, had been completely transformed into a professional, organised facility. It was far bigger and more sophisticated, and when I was invited to see a few patients again, I agreed despite feeling rather rusty. There were now thousands of patients on regular follow-up with universal access to ARVs.

My first patient walked in. She looked healthy and happy. She asked if I remembered her. I drew a blank.

But when she hugged me, I realised it was MC! She had survived, thanks to ARVs that were introduced a few years after I had left. This emotional reunion reminded me that there’s always hope, no matter how bleak things may seem. Just start — even when the end isn’t clear.

Today, diagnostics have evolved from cumbersome ceremonies into rapid, accessible point-of-care tests. The requirement for counselling has been streamlined, and what was once a complex cocktail of medications administered multiple times daily has been simplified to a single daily pill. This eases the burden on patients and improves treatment adherence.

Diagnostics and treatments reach even the most underserved communities. Clinical AIDS cases have dwindled – becoming almost non-existent thanks to early diagnosis and the evolution of ARVs. And thanks to freely available information and education, the stigma has also diminished.

The theme of World AIDS Day 2023, “Let Communities Lead,” resonates deeply with this transformative journey. Communities have emerged as vital agents of change in our battle against HIV/AIDS, dispelling myths and supporting those affected. Communities throughout Africa have taken charge of their response to HIV/AIDS, recognising it as a chronic condition that can be managed.

Looking ahead, the road to defeating HIV/AIDS is still long. We must safeguard the gains we have made because the virus has not gone away. Our continued commitment to research, development and community-led initiatives is crucial.

Africa remains disproportionately affected by HIV

In 2022, there were 20.8 million people with HIV in eastern and southern Africa. The continent’s economic powerhouses, South Africa and Nigeria, are among the 10 countries with the most HIV cases (South Africa at 7,800,000 in 2020 and Nigeria at 1,700,00 in the same year).

As diagnostics continue to evolve, integrated testing is on the rise, using existing infrastructure to test for several diseases simultaneously, making testing more affordable and efficient. We anticipate better treatment options on the horizon and possibly even the ever-elusive HIV vaccine.

Diagnostics have historically been grossly underfunded. Most people may not realise that on average, less than 5% of national Health budgets go to diagnostics.

This year, the WHO (World Health Organization) member countries voted to adopt the resolution on “Strengthening diagnostics capacity”. With early diagnosis being prioritised across the continent, more people have a chance at getting treatment. A resolution, however, is not legally binding; and funding is never guaranteed.

One of the most prominent patrons dedicated to ending HIV/AIDS by 2030 – The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) – faces an uncertain future. We can’t take our foot off the pedal yet, especially with key funders under fire.

Local governments must recognise that we need to reallocate existing health budgets more strategically. Public health allocations should strike a better budgetary balance between diagnostics and treatment.

Finding the right formula is a collective effort involving public-private partnerships that also allow governments to leverage private resources to serve more patients.

Ongoing investments in medically focused human capital are vital, and when all these building blocks fall into place, an end to HIV/AIDS could be in sight.

Here’s to survivors like MC, who allow themselves to live in hope! We celebrate what we have achieved so far, but let’s continue to partner to build better healthcare systems, drive access for all patients and eradicate stigma.

*DR. ALLAN PAMBA is the Executive Vice-President Diagnostics, Africa at Roche Diagnostics

As we collectively process the outcomes from the 2023 World Health Assembly (WHA), which serendipitously took place during the same week as Africa Day – a celebration of African unity, we are witnessing history in the making.

Earlier this year, the WHO (World Health Organization) Executive Board voted in favour of including the resolution “Strengthening diagnostics capacity” on the WHA 2023 agenda.

This is a critical victory for African people. It signalled a firm understanding by the WHO of the importance of increasing access to quality diagnostics in low-to-middle-income countries (LMICs) – and particularly African countries. 

Today, diagnostics can drive 70% of all clinical decision making, yet they are apportioned less than 5% of hospital budgets.

The Lancet Commission on Diagnostics indicates that the median availability of diagnostics is at circa 19% in basic primary care facilities surveyed in low-income and lower-middle-income countries.

Diagnostic laboratory services are essential to the delivery of quality healthcare but have historically been a neglected component of health systems in LMICs.^1,2 

Grossly limited access to timely, good quality diagnostics remains the weakest link in the health-care cascade. Diagnosis informs treatment and care decisions right at the beginning of any patient’s healthcare journey. Consequently, prioritising diagnostics across Africa can empower individuals, improve health outcomes and ultimately drive economic growth – because healthier populations are more economically active.³ 

It is pivotal that the WHA has formally recognised and elevated the important place of diagnostics for the first time. This is a call to action that goes beyond the efforts of any single government or organisation.

It requires a concerted and coordinated effort from all stakeholders to address the systemic barriers that hinder access to quality diagnostics.

This WHA Resolution opens the door for policy changes, new partnerships and resource mobilization to drive tangible progress towards building resilient healthcare systems in Africa and beyond. Such progress is key to secure Global Health security.

On the Pan-African Organisation’s 60^th Anniversary, the focus for Africa Day this year is “Accelerating the implementation of the African Continental Free Trade Area to bring greater prosperity to the continent”. This links firmly to the 2023 WHA theme, “WHO at 75: Saving lives, driving health for all,” because prosperity and health are but two sides of the same coin.

The World Bank highlights that “Universal healthcare allows countries to make the most of their strongest asset: human capital. Supporting health represents a foundational investment in human capital and economic growth”.

Diagnosis is the cornerstone of universal healthcare. The WHA’s acknowledgement of the value of diagnostics reinforces the need to ensure diagnostic testing reaches even the most remote communities.

Only through collaboration can we create sustainable and inclusive healthcare systems that correctly prioritise the needs of people and, ultimately, allow African economies to thrive – Public Private Partnerships are one vehicle.

The WHA has signalled that governments should recognise diagnostics’ vital role and prioritise their inclusion in national health agendas.

Leveraging partnership with the Private sector, Governments have an opportunity to invest in significantly strengthening laboratory infrastructure, improving supply chain management and implementing quality assurance programmes that create coherent healthcare journeys. 

Policies that promote diagnostics at the primary healthcare level and facilitate reimbursement mechanisms will go a long way in ensuring equitable access where access is limited by poverty.

In the private sector, we must continue to advocate for member countries to support the proposed resolution and focus on the 2030 sustainable development agenda.

Although a resolution is not legally binding, it is a powerful indication of the issues the WHO deems important and worthy of attention.

The WHO resolution contains clear recommendations and calls to action for member states and prompts a monumental mindset shift, urging policymakers to commit and establish national diagnostics strategies.

These strategies encompass infrastructure, workforce capacity and smart regulatory design.

As providers of healthcare solutions, we will seize this opportunity to establish a more significant investment in diagnostics as a pillar of health system resilience and health security and prioritise diagnostics in funding negotiations with government stakeholders. 

The creation of robust healthcare systems requires a long-term vision. It demands sustainable funding models that ensure the availability and affordability of diagnostics for al.

Initiatives that build innovative financing mechanisms – like public-private partnerships, insurance schemes and international funding commitments – are catalysts for healthier, more prosperous people.  A timely investment now is an investment in the health and well-being of future generations.

The WHA has given diagnostics time to shine, and we must pool resources, expertise and technology to accelerate progress. Now, more than ever, increasing the percentage of healthcare budgets allocated to diagnostics is crucial. 

A simple HIV viral load test can determine the amount of HIV circulating in a body and confirm if patients are responding to medication or if second-line therapies should be considered. Roche created the Global Access Programme to contribute to the UNAIDS 95-95-95 goal of treatment for all.

Through the programme, Roche is expanding access to quality, sustainable diagnostic testing for countries hardest hit by HIV.⁶ over the last 9 years, Roche has leveraged the power of partnership and today delivers circa 60% of all HIV viral load testing in Africa. 

Diagnosis is the catalyst for more effective disease management and better quality of life.  New  analysis from the Centers for Disease Control and Prevention reveals that the number of people receiving lifesaving HIV treatment through PEPFAR has increased 300 times in under 20 years, from 2004 to 2022.^6,7 

Early, accurate diagnosis enables appropriate and targeted treatments, reducing the need for prolonged hospital stays, unnecessary procedures and ineffective medications. As the World Health Assembly concludes and we reflect on the key takeaways, we can celebrate that diagnostics are no longer an afterthought but have been formally acknowledged as a central pillar of healthcare. 

This giant leap provides a solid foundation for driving change in Africa. Now, we must work together to translate these global commitments into actionable steps, ensuring that diagnostics are accessible, affordable and integrated into healthcare systems across the continent.

Together, we can empower individuals, build resilient healthcare systems and save lives. Let’s seize this opportunity to power progress, transform the narrative and ensure that every African has access to quality diagnostics and healthcare.