Kampala, Uganda — Dr. Isaac Ssewanyana was a teenager when the full force of Uganda's HIV epidemic struck home. A cousin - also a close friend - contracted HIV.
"I wanted to be a doctor so I could be part of the solution," he says.
He was drawn to the laboratory, where he could experiment and find a cure for a disease that, by the 1980s, impacted nearly a third of Uganda's population.
Dr. Isaac was one of the youngest researchers recruited by the International AIDS Vaccine Initiative at the Uganda Virus Research Institute to develop a vaccine for HIV. But strict focus on a single disease felt limiting.
Today, Dr. Isaac is Director of Laboratory Services at the Central Public Health Laboratory, one of a constellation of facilities that make up Uganda's National Health Laboratories and Diagnostic Services in Kampala.
Dr. Isaac's lab conducts basic research, tests and analyzes a variety of samples that flow into the laboratory complex via National Health Laboratories' formidable sample transportation network.
Laboratories are centers for discovery and experimentation, and for identifying and quickly responding to emerging health threats before they spread. They are also an essential part of resilient, strong health systems that can evolve and adapt as the world changes.
Uganda's robust laboratory system has been essential to the country's response to mpox, quickly identifying cases and working to prevent, detect and respond to the outbreak.
The Global Fund has invested US$36 million in Uganda's laboratory systems since 2020 and has plans to invest an additional US$8.8 million more.
This includes funds for National Health Laboratories to hire more laboratory technicians, procure essential medical supplies such as reagents and bring in top-of-the-line equipment to help scientists investigate and prevent deadly diseases.
The sample transportation network is one of National Health Laboratories' key innovations, designed in response to the HIV crisis that fueled Dr. Isaac's early desire to become a doctor.
By the turn of the 21st century, most experts agreed that new cases of HIV in Uganda were declining - but thousands of people in hard-to-reach places weren't getting tested.
"People thought: There is no HIV in rural areas," says Rebecca Nakidde, national coordinator of the sample transportation network. "But that's because we were not reaching them. We weren't seeing the full picture."
Riders for Uganda's sample transportation network bring medical samples to National Health Laboratories and Diagnostic Services from health facilities across the country. National Health Laboratories' sample transportation network launched in 2007 with one driver who traversed 26 districts over several weeks, collecting samples for testing. It took about two months to get a result.
Today, a fleet of 22 trucks and 400 motorcycles bring up to 8,000 samples from across the country to National Health Laboratories every day.
There, massive Abbott Molecular Diagnostic machines analyze RNA, DNA and proteins in the samples, scanning for signs of infection, and churn out 96 results every 30 minutes.
Those results go back to the patient via an online portal - or on the back of another sample transportation network motorbike.
"Any service here is accessible to every Ugandan, whoever they are," says Dr. Isaac. "We want to break the paradigm of the person going to the facility and bring the facility to the person."
Medical Laboratory Scientist and Lab Supervisor Samuel Mukuru at Uganda's National Health Laboratories and Diagnostic Services. When COVID-19 struck, the sample transportation network formed the basis of National Health Laboratories' response: a built-in system to reach and test patients and monitor infections nationwide.
The global pandemic ushered in a wave of research and technological innovations, building upon existing infrastructure and expertise.
National Health Laboratories set up a mobile laboratory equipped with portable biosafety equipment so that laboratory technicians can travel quickly to the site of an outbreak, and safely test and identify dangerous pathogens such as COVID-19, Ebola and Marburg virus.
Mobile laboratory team leaders Godfrey Pimundu and Tonny Muyigi wear disposable smocks at all times, and train frequently to prepare for the next outbreak - they are always ready to respond. In July, these mobile testing teams quickly confirmed two mpox cases in the Kasese district, near Uganda's border with the Democratic Republic of Congo. Their rapid diagnosis allowed health authorities to ensure prevention and other health measures were in place. Teams continue to test and monitor the evolution of the outbreak.
Uganda's National Tuberculosis Reference Laboratory (NTRL), part of the National Health Laboratories campus, uses next-generation sequencing technology to map and scan for drug-resistant strains of TB. The same equipment - procured with Global Fund support - helped scientists and health officials track cases of COVID-19, and later Ebola, across the country.
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With support from the Global Fund, NTRL shares its methods and expertise with neighboring countries so that efforts to identify and isolate emerging, deadly diseases don't stop at the border. The reference laboratory supports more than 20 countries across Sub-Saharan Africa to use sequencing for surveillance - and prepare the entire region for the health threats to come.
National Health Laboratories helps ensure that Uganda's health systems are prepared for a future in which new pathogens, extreme weather and other barriers to reaching people with essential care could threaten Uganda's response to disease outbreaks.
"We need to expand the scope," says Dr. Susan Nabadda Ndidde, Commissioner and Executive Director of National Health Laboratories. "With emerging and re-emerging diseases, including the ongoing mpox outbreak, and the changes that we are seeing for patients - we need to have very strong lab systems that are able to respond."
Written by Elise Walter. Photos by Brian Otieno. With many thanks to colleagues at Uganda's National Health Laboratories and Diagnostic Services.
