In addition, other peripheral factors which influence the success of the treatment come into play in a country such as Chad. “You also have to factor in shortages. There are periods when there is quite simply no medicine”. Chad is effectively a landlocked country which shares 5,676 kilometers of borders with 6 countries: The Sudan, The Central African Republic, Libya, Nigeria, Cameroon and Niger.  So given its location, Chad remains dependent on the situation in its neighboring countries and derives no benefit from conflicts, crises or geopolitical disorder that may occur in these countries. It is to be noted that the nearest port is that of Douala (Cameroon) 1700 km from N’Djamena and the roads are not always good. The state of infrastructure has an impact both in terms of the supply of medication to Chad and the motivation of patients whom live far from the capital to undertake journeys.

It is clear; living with HIV in Chad is totally different to what a patient in Europe experiences, for example. Consequently, the fight against the disease involves the development of strategies in the field.

Investment in molecular biology and qualified personnel

This is exactly what Chatté Adawaye suggests in his thesis (1). His first observation is reinforced by a sharp empirical knowledge. Indeed, Chatté Adawaye belongs to a group called the HCNC (High National Council for Co-ordination of World Funding for the fight against malaria, AIDS and tuberculosis) which is responsible for negotiating the necessary funding for the fight against the three diseases, malaria, HIV and tuberculosis that are veritable plagues in Chad.  This particular position enables him to state that the political will exists and the financial means are available. “Every year, the World Bank increases finance. Moreover, in Chad, individuals with HIV have free access to ARV drugs as well as complementary examinations since 2007. To cap it all, since 2003, the country has become a petrol-producing nation”.  However, these assets are not sufficient if, at the same time, the resources are not allotted effectively. “There is nothing to be gained from investing in technical means if we do not have the required qualified personnel to use it. Everything comes back to human resources and it is the meaning of the message we have sent to the competent authorities following this study”. In practical terms, this means that it is necessary to create an AIDS Reference Center for better care of people living with HIV and there is an urgent need for investment in molecular biology and the required qualified personnel. This goes hand-in-hand with solid and reliable infrastructure. We have mentioned the problem of poor roads above. Added to this are frequent electricity cuts which constitute a major handicap when we consider that to take a blood sample, it is necessary to maintain a temperature of -80°C! Breaking the cold chain has the effect of distorting the results.

Faced with these constraints, Chatté Adawaye’s thesis aims to suggest pragmatic alternative methods of treatment for people living with HIV by taking account of the realities that apply in the field. These proposals are based on three central points which are the buvard blotting-paper method of blood sample-taking or DBS (Dried Blood Spot), measuring CD4 cells and the viral load and finally, the detection of isolated resistance mutations.

The first stage of care is evidently taking of blood samples which precede analysis. We have explained above that the frequent electricity cuts in particular made conservation and transportation of plasma difficult. The alternative would consist of using another technique of sampling which has not yet been tested in Chad: the DPS or DBS method. The technique consists of collecting total blood total (DBS) or plasma (DPS) on filter paper called buvard. This technique has several non-negligible advantages. First, it does not require the cold chain because the sample only needs to be kept at room temperature. In addition, it can be taken by personnel who are not qualified in molecular biology which means that patients can go to a medical center even in the outskirts. Finally, the sample can simply be sent by post. The preservation and transportation constraints are therefore avoided. Finally, the sample can be sent by normal post. The constraints related to conservation and transportation are therefore avoided. As for the results, these are as reliable as those obtained by standard sample-taking (plasma). For children, it is just a matter of pricking the end of the finger to have a correct sample. The method is therefore not really restrictive!

(1) New genotypical approaches for the monitoring of HIV resistance to ARV drugs in countries with limited resources: the case of Chad. Doctoral thesis of Chatté Idékhim ADAWAYE completed under the supervision of Michel MOUTSCHEN, University of Liege, 2014.