Challenges with Molecular Waste Management in sub-Saharan Africa – HIV Viral Load and COVID

Main Article Content

Shirley Lecher David Bressler Monte Martin

Abstract

Introduction: Waste generated from HIV viral load testing and SARS CoV-2 for diagnosis of COVID-19 contains potentially hazardous guanidinium thiocyanate. Guanidinium thiocyanate may be toxic to humans and if not properly disposed of can pollute waters and harm aquatic life. Sub-Saharan African countries are particularly challenged by limited resources to suitably manage waste generated at health care facilities and laboratories. There is a need to identify waste management challenges and develop strategies to mitigate this type of laboratory testing waste in resource limited countries.


Methods: HIV viral load data used for this analysis were standardized monitoring evaluation and reporting Presidents Emergency Plan for AIDS Relief datasets for Malawi, Mozambique, South Africa, and Zimbabwe. COVID-19 data was obtained from the Johns Hopkins Coronavirus Resource Center.  


Discussion: Inadequate management of HIV viral load and COVID-19 guanidinium thiocyanate waste due to lack of policy, guidelines and appropriate procedures for containment, poses a significant public health threat to the environment. Recognizing this gap, the United States Centers for Disease Control and Prevention has decided to provide technical expertise, raise awareness, and work with other international partners to disseminate knowledge and find solutions for the Presidents Emergency Plan for AIDS Relief supported countries in sub-Saharan Africa. The World Health Organization guidelines on safe management of waste from healthcare activities were proposed as a starting point to develop country specific guidelines.


Conclusions: The United States Centers for Disease Control and Prevention, in collaboration with other international partners, is diligently working to provide technical assistance to countries for training and development of mitigation strategies to appropriately manage guanidinium thiocyanate containing waste. Waste management is a growing problem as molecular testing for HIV, COVID-19, and other emerging diseases increase.

Article Details

How to Cite
LECHER, Shirley; BRESSLER, David; MARTIN, Monte. Challenges with Molecular Waste Management in sub-Saharan Africa – HIV Viral Load and COVID. Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5330>. Date accessed: 27 may 2024. doi: https://doi.org/10.18103/mra.v12i4.5330.
Section
Research Articles

References

1. The World Bank. Solid waste management. Accessed 10 June 2023.
https://www.worldbank.org/en/topic/urbandevelopment/brief/solid-waste-management

2. WHO publication: Safe management of wastes from health-care activities, 2nd ed. WHO.int 2014. Accessed 1 March 2024 https://www.who.int/publications/i/item/9789241548564

3. Lecher S, Fongungo P, Ellenberger D. Adje Toure C, Alemnji G, Basiye F, et al. HIV Viral load monitoring among patients receiving antiretroviral therapy- Eight sub-Saharan Africa Countries, 2013-2018. MMWR. 2021; 70 (21) 775-778. https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7021a2-H.pdf doi:10.15585/mmwr.mm7021a2

4. UNAIDS 2023. Global HIV & AIDS statistics — 2023 fact sheet. Accessed 20 February 2024. Global HIV & AIDS statistics — Fact sheet | UNAIDS

5. van Schalkwyk C, Mahy M, Johnson LF, Imai-Eaton, JW. Updated Data and Methods for the 2023 UNAIDS HIV Estimates. J Acquir Immune Defic Syndr. 2024 Jan 1; 95(1 Suppl): e1–e4. Accessed 20 March 2024.
https://journals.lww.com/jaids/fulltext/2024/01011/updated_data_and_methods_for_the_2023_unaids_hiv.1.aspx.
doi: 10.1097/QAI.0000000000003344

6. Sleeman K, Hurlston CM, Diallo K, Zeh C, Riley P, Alexander H, et al. Strengthening Waste Management during HIV Viral Load Scale-up. 2018. ASLM 2018 International Conference, Abuja, Nigeria. Abstract no. PS-2.3a-093 Page 107

7. Biospectra. Guanidium thiocyanate material data sheet. Accessed 1 March 2020. https://www.biospectra.us/images/sds/Guanidine-Thiocyanate-SDS.pdf

8. Collins Otieno Odhiambo, Anafi Mataka, Getachew Kassa, Pascale Ondoa. Managing laboratory waste from HIV-related molecular testing: Lessons learned from African countries. Journal of Hazardous Materials Letters. 2021 (2) 100030. https://doi.org/10.1016/j.hazl.2021.100030

9. Presidents Emergency Plan for AIDS Relief. PEPFAR Panorama Spotlight 2023. Accessed 1 March 2024.
https://data.pepfar.gov/additionalData

10. South African National Standard 10248: Management of healthcare risk waste from a Healthcare facility. Accessed 1 March 2024. https://archive.org/details/za.sans.10248.1.2008/page/n1/mode/2up

11. Johns Hopkins University. Johns Hopkins Coronavirus Research Center Global cases and trends. Accessed 1 March. https://coronavirus.jhu.edu/data

12. WHO 2024. WHO COVID-19 dashboard. Accessed 1 March 2024.
https://data.who.int/dashboards/covid19/cases?n=c

13. Mondal R, Mishra S, Pillai JSK, Sahoo MC. COVID 19 Pandemic and biomedical waste management practices in healthcare system. J Family Med Prim Care. 2022 Feb; 11(2):439-446. doi: 10.4103/jfmpc.jfmpc_1139_21.

14. Kothari R, Sahab S, Singh HM, Singh RP, Singh B, Pathania D, Singh A, et al. COVID-19 and waste management in Indian scenario: challenges and possible solutions. Environ Sci Pollut Res Int. 2021 Oct;28(38):52702-52723. doi: 10.1007/s11356-021-15028-5.

15. Adusei-Gyamfi, J, Boateng KS, Sulemana A, Hogarh JN. Post COVID-19 recovery: Challenges and opportunities for solid waste management in Africa. Environ Chall (Amst). 2022 Jan 6: 100442.
doi: 10.1016/j.envc.2022.100442

16. Managing COVID-19 waste. No authors listed. Bull World Health Organ. 2022; 100: 243–244. Accessed 20 March 2024.
http://dx.doi.org/10.2471/BLT.22.020422

17. Jayasinghe PA, Jalilzadeh H, Hettiaratchi P. The Impact of COVID-19 on Waste Infrastructure: Lessons learned and Opportunities for a Sustainable Future. Int J Environ Res Public Health. 2023 Feb 28;20(5):4310.
doi: 10.3390/ijerph20054310