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We read with interest the article by Songa et al. because we are similarly confronted with the frequent occurrence of symptomatic hyperlactatemia/lactic acidosis (SH/LA) in our program in Rwanda. With current efforts to decentralize antiretroviral treatment most patients will soon receive treatment through health care centers that are staffed mainly by nurses and that have fewer diagnostic tools available. Songa and colleagues encourage field-testing of point-of-care devices (POCDs) in Africa. We report our experience with access to a POCD at a health care center- and nurse-based antiretroviral treatment program. Medecins Sans Frontieres started offering antiretroviral treatment on a decentralized level in Rwanda in 2003 supporting 2 urban government clinics in Kigali. The program relies extensively on nurses for provision of care and has seen a fast scaling-up (i.e. >3000 patients have started receiving treatment). (excerpt)

Symptomatic Hyperlactatemia: Lessons Learned Using a Point-of-Care Device in a Health Care Center- and Nurse-Based Antiretroviral Program in Rwanda