Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa

Abstract

Background: This prospective pilot study explored same-day point-of-care viral load testing in a setting in Ghana that has yet to implement virological monitoring of antiretroviral therapy (ART). Methods: Consecutive patients accessing outpatient care while on ART underwent HIV-1 RNA quantification by Xpert. Those with viraemia at the first measurement (T0) received immediate adherence counselling and were reassessed 8 weeks later (T1). Predictors of virological status were determined by logistic regression analysis. Drug resistance-associated mutations (RAMs) were detected by Sanger sequencing. Findings: At T0, participants had received treatment for a median of 8¢9 years; 297/333 (89¢2%) were on NNRTI-based ART. The viral load was 40 copies/mL in 164/333 (49¢2%) patients and 1000 copies/mL in 71/ 333 (21¢3%). In the latter group, 50/65 (76¢9%) and 55/65 (84¢6%) harboured NRTI and NNRTI RAMs, respectively, and 27/65 (41¢5%) had 1 tenofovir RAM. Among 150/164 (91¢5%) viraemic patients that reattended at T1, 32/150 (21¢3%) showed resuppression <40 copies/mL, comprising 1/65 (1¢5%) subjects with T0 viral load 1000 copies/mL and 31/85 (36¢5%) subjects with lower levels. A T0 viral load 1000 copies/mL and detection of RAMs predicted ongoing T1 viraemia independently of self-reported adherence levels. Among participants with T0 viral load 1000 copies/mL, 23/65 (35¢4%) showed resuppression <1000 copies/mL; the response was more likely among those with higher adherence levels and no RAMs. Interpretation: Same-day point-of-care viral load testing was feasible and revealed poor virological control and suboptimal resuppression rates despite adherence counselling. Controlled studies should determine optimal triaging modalities for same-day versus deferred viral load testing.

Measuring and explaining inequality of continuous care for people living with HIV receiving antiretroviral therapy in Kunming, China

“…Different directions were shown for monitoring treatment outcomes in our study. Most participants received adequate immunological response monitoring, whereas 84.2% lacked adequate routine virological monitoring [ 21 ], which was lower than in a previous study in sub-setting in sub-Saharan Africa [ 52 ]. Interestingly, virological response monitoring was non-significant in favor of the poor in our research, and SES contributed minimally to the uptake of intensive viral load testing in Kunming.…”

Continuous quality improvement (CQI) Institutionalization to reach 95:95:95 HIV targets: a multicountry experience from the Global South

“…Through our CQI approach, we were able to increase PNS outcomes and the capacity of health providers and community systems in HIV identification to encourage more partner-initiated counselling for HIV testing. This experience showed that despite overstretched health systems, economic constraints, limited or poor training and inadequate laboratory infrastructure [ 19 ], facilities can apply CQI approaches and learn to use data to review their performances and make changes to improve their quality of care. The facilities described in the first case study achieved the aim of identifying more HIV-positive individuals, connecting them with the healthcare system, and getting them enrolled in HIV services, which contributed to overall improvements in HIV treatment with a reduction in the risk of transmission.…”

HIV-1 re-suppression on a first-line regimen despite the presence of phenotypic drug resistance

“…Viral load monitoring has proven to be an important tool in monitoring and reinforcing adherence [8]. Same-day pointof-care viral load testing has shown to be useful in identifying patients who require immediate adherence councelling [36]. The inclusion of biomarkers and self-reported adherence could produce a potentially more accurate measure of adherence to cART [37].…”