From Zimbabwe's first diagnosed case of HIV/AIDS in 1985, up to 1997, the country's health situation became increasingly dire. At the disease's peak between 2000 and 2003, according to health statistics, 29 percent of the population was infected. Since then Zimbabwe has made significant strides in the fight against HIV/AIDS, and a Bahamian has been in the middle of it. Shanette Nixon, a consultant for the Association of Public Health Laboratories (APHL), has worked extensively, training scientists in the evaluation and testing of HIV/AIDS in Zimbabwe.
Through her work with APHL, Nixon, a clinical laboratory scientist goes into countries, builds its local testing capacity, by training a local to take over the program and build on it. When she feels comfortable they can lead the project, she moves on.
In February 2015 she was posted to Zimbabwe where she singlehandedly started the external quality assessment program, where she worked to ensure that 100 HIV testing sites were giving 100 percent correct results to patients. The number of sites giving accurate results significantly increased under Nixon.
Working in collaboration with Zimbabwe's Ministry of Health and National Microbiology Reference Laboratory, APHL -- the only PEPFAR (President's Emergency Plan For AIDS Relief) laboratory partner in the country -- adopted a comprehensive approach to improving testing quality, one that leads to better diagnosis and treatment. The association is developing external quality assurance systems to verify test results. Already half of Zimbabwe's 1,848 testing sites are using this method successfully to ensure the quality of laboratory services.
"Many folks say that point-of-care testing eliminates the barriers to HIV treatment in one step. The quick results are a huge advantage and the tests can be highly accurate -- but only if properly trained people perform the tests. That's why, when I'm training a scientist, I keep in mind that I'm affecting one person who can affect millions. Once the ministry gives us the go-ahead to train scientists in the remaining provinces, everyone will have full access, no matter where they are," said Nixon.
Zimbabwe is striving to achieve the United Nations' 90/90/90 goal -- 90 percent of people living with HIV (Human Immunodeficiency Virus) to know their status; 90 percent of people diagnosed HIV positive to be on sustained antiretroviral treatment (ART); and 90 percent of those on ART to have an undetectable viral load.
HIV prevalence in Zimbabwe has been reduced to 16 percent (2015 estimate) -- 1.6 million people.
By 2012, the percentage of Zimbabweans living with HIV who knew their status was estimated to be 66 percent; of those, ART coverage was at 55 percent, according to Nixon. She said viral load test availability was extremely low in 2015, but the 2016 figures are expected to increase dramatically, due to the newly established viral-load testing program. Developed with APHL's support, six provincial super-laboratories now have the infrastructure, equipment, personnel and supply chain support to perform routine viral load testing.
Nixon said a problem across the African continent was that patients were getting incorrect results. She said the same is true for a lot of developing countries as well; this is where she comes in, training the workers to perform accurate testing.
APHL has proved critical in the establishment of quality point-of-care testing, which has meant quicker and more reliable test results. The work was implemented primarily by Nixon, assisted by Goodridge Mguni, APHL's external quality assurance manager for Zimbabwe. Together, they built capacity at the National Microbiology Reference Laboratory to produce dried tube specimen panels that can be preserved for up to a year without refrigeration, for health testing sites to ensure quality assurance and control.
"A lot of the workers who do the testing, some of them may not be highly skilled laboratory personnel according to the countries we are in, and some of them may not be lab people at all, so that's how my work has impacted Zimbabweans, by giving accurate results," she said.
Nixon said creating institutional memory and standardizing testing practices at the labs is important. She said an easy way with people helps motivate them to keep up the techniques they're being taught, and she has seen how eager they are to ensure success.
Given the country's warm climate, she said the panels could be key to achieving universal access to quality HIV testing in Zimbabwe, but that they require new training for rapid diagnostic HIV testers, who already shoulder many tasks; this is why she and Mguni worked hard to train as many people as possible.
Nixon's work in Africa did not begin with her 2015 Zimbabwe posting. She actually started her work on the African continent in 2009 as a research laboratory manager with Emery University, before taking on another position in 2010 with Duke University.
Her first posting to Zambia was an unpaid position.
"I had left my job in the United States and had moved home and was unable to find employment. I put my CV back out on the international market, and it literally was a situation where a colleague was like, we have a position, but it's an unpaid position for you to get your feet wet in the international market, and so I took it. When I first moved to Africa, I was just working on a stipend to be able to live. That was like the door opening for me to get into the international research laboratory world of which there is a very small group of us, and pretty much everyone knows everyone. From there I went to Tanzania [2010 to 2014], where I was in charge of U.S. critical trials for HIV studies sponsored by the National Institute of Health, and from there I went on to becoming a consultant with APHL, who I'm currently working with."
As a consultant, Nixon supports the ministry of health in various countries and provides them with technical assistance and expertise. She helps them with strengthening laboratory systems throughout their country.
"I go in and assess the laboratories and make recommendations based on what I've seen, and in specific, a lot of my work has been with regards to reducing the burden of HIV/AIDS in these countries through whatever programs I see that would assist in ensuring that quality laboratory services are delivered to the public, and especially with regards to HIV, because that's where a lot of the funding is being driven from... it's from HIV donors -- Bill and Melinda Gates, the Clinton Foundation, and in specific to funds that I'm subcontracted, or paid through is the PEPFAR funds."
With her work in Zimbabwe concluded, Nixon will spend the Christmas holidays at home, but has already been contacted by the ministry of health from a South American country to assist them with validations for laboratory information systems, which she said would probably be her next assignment.
On average, Nixon's assignments last anywhere from three months to a year.
The clinical laboratory scientist says her work gives her a sense that this is what life is meant to be when she sees her knowledge and skill set bringing out success in others.
"For me, that's the thrilling part about why I do what I do, and just knowing that the knowledge and skills that I'm sharing in the case of Africa affects millions actually, and in smaller developing countries it will affect hundreds of thousands, that in itself is self-rewarding, and I get a lot of self-gratification from it."

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