Measures of viral load using Abbott RealTime HIV-1 Assay on venous and fingerstick dried blood spots from provider-collected specimens in Malawian District Hospitals

Rutstein, Sarah E.; Kamwendo, Deborah; Lebah, Lugali,; Thengolose, Isaac; Tegha, Gerald; Fiscus, Susan A.; Nelson, Julie A.; Hosseinipour, Mina C.; Sarr, Abdoulaye; Gupta, Sundeep; Chimbwandira, Frank; Mwenda, Reuben; Mataya, Ronald

doi:10.1016/j.jcv.2014.05.005

Cited by 39 publications

(33 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared to other cohorts in Malawi 6 and elsewhere, suppression rates were lower than UNAIDS targets of 90% among individuals on ART thereby potentially compromising health gains for the mother and increasing transmission risk to the infant. In part, this higher rate was due to our failure definition of < 1000 copies/ml that was defined by Malawi guidelines and the appropriate threshold for DBS testing, but is not directly comparable to other surveys that have reported at lower VL thresholds.…”

Section: Discussionmentioning

confidence: 60%

“…To date, results suggest high levels of suppression among patients retained in care. 6 The current schedule for monitoring includes HIVRNA testing at 6 months post ART initiation, 2 years, and every 2 years thereafter. The 6 month collection time point, early in the treatment course, is designed to detect early adherence problems that may be addressed through appropriate counseling interventions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study

Hosseinipour¹,

Nelson

Trapence

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Background In 2011, Malawi launched Option B+, a program of universal ART treatment for pregnant and lactating women to optimize maternal health and prevent pediatric HIV infection. For optimal outcomes, women need to achieve HIVRNA suppression. We report 6 month HIVRNA suppression and HIV drug resistance in the PURE study. Methods PURE study was a cluster-randomized controlled trial evaluating three strategies for promoting uptake and retention; Arm 1: Standard of Care, Arm 2: Facility Peer Support and Arm 3: Community Peer support. Pregnant and breastfeeding mothers were enrolled and followed according to Malawi ART guidelines. Dried blood spots for HIVRNA testing were collected at 6 months. Samples with ART failure (HIVRNA ≥1000 copies/ml) had resistance testing. We calculated odds ratios for ART failure using generalized estimating equations with a logit link and binomial distribution. Results We enrolled 1269 women across 21 sites in Southern and Central Malawi. Most enrolled while pregnant(86%) and were WHO Stage 1(95%). At 6 months, 950/1269 (75%) were retained; 833/950 (88%) had HIVRNA testing conducted and 699/833(84%) were suppressed. Among those with HIVRNA ≥1000 copies/ml with successful amplification (N=55, 41% of all VL> 1000 copies/ml), confirmed HIV resistance was found in 35% (19/55), primarily to the Non-nucleoside reverse transcriptase inhibitors(NNRTI) class of drugs. ART failure was associated with treatment default but not study arm, age, WHO stage, or breastfeeding status. Conclusions Virologic suppression at 6 months was <90% targets, but the observed confirmed resistance rates suggest adherence support should be the primary approach for early failure in Option B+.

show abstract

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study

Hosseinipour¹,

Nelson

Trapence

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

show abstract

“…Human resource capacity among clinical health care workers is a key consideration in VL monitoring implementation in resource-limited settings(WHO, 2014). Task-shifting to lower-cadre health workers could redistribute current responsibilities, especially with non-phlebotomy-based specimen collection (i.e., fingerstick DBS cards) (Callaghan, et al, 2010; Pannus, et al, 2014; S. E. Rutstein, et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…(S. Rutstein, D. Kamwendo, et al, 2014; S. E. Rutstein et al, 2014)Target study enrollment ranged from 250-450 ART patients, depending on clinic size and pace of enrollment ( Table I ).…”

Section: Methodsmentioning

confidence: 99%

On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings

et al. 2015

View full text Add to dashboard Cite

Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n=17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers’ knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision making. Results from our study provide unique insight into provider perceptions of VL monitoring and indicate the importance of policies responsive to individual and environmental challenges of VL monitoring program implementation. Findings may inform scale-up by helping policymakers identify strategies to improve feasibility and sustainability of VL monitoring.

show abstract

“…FSW were classified as nonsuppressed with an HIV-1 RNA >5000 copies/mL, the WHO’s recommended threshold when using fingerstick dried blood spots (Arredondo et al, 2012; Rutstein et al, 2014; World Health Organization, 2012). …”

Section: Methodsmentioning

confidence: 99%

The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi

et al. 2016

Self Cite

View full text Add to dashboard Cite

Female sex workers (FSW) have a high prevalence of substance use and HIV, but the impact of substance use on HIV treatment engagement is not well established. We evaluated the association between alcohol and marijuana use and sub-optimal HIV treatment engagement outcomes among HIV-infected FSW in Lilongwe, Malawi. We enroled FSW using venue-based recruitment into a cross-sectional evaluation assessing substance use and HIV treatment engagement. Seropositive FSW, identified through HIV rapid testing, received rapid CD4 count and viral load testing. We used Poisson regression with robust variance estimates to ascertain associations of alcohol and marijuana use with sub-optimal HIV treatment outcomes: (1) lack of ART use among previously diagnosed, ART-eligible FSW and (2) viral nonsuppression among FSW on ART. Of previously diagnosed, ART-eligible FSW (n = 96), 29% were not using ART. Patterns of hazardous drinking were identified in 30%, harmful drinking in 10%, and alcohol dependence in 12%. ART-eligible FSW with harmful drinking or alcohol dependency were 1.9 (95% CI: 1.0, 3.8) times as likely to not use ART compared to FSW without harmful or dependent drinking. Among those on ART, 14% were virally nonsuppressed. The prevalence ratio for viral nonsuppression was 2.0 (95% CI: 0.6, 6.5) for harmful drinkers and alcohol-dependent FSW. Over 30% of ART-eligible FSW reported using marijuana. Marijuana-using FSW were 1.9 (95% CI: 0.8, 4.6) times as likely to not use ART compared to FSW who were not using marijuana. Given the high prevalence of alcohol use and its association with lack of ART use, ART uptake and alcohol reduction strategies should be tailored for alcohol-using FSW in Malawi.

show abstract

Measures of viral load using Abbott RealTime HIV-1 Assay on venous and fingerstick dried blood spots from provider-collected specimens in Malawian District Hospitals

Cited by 39 publications

References 42 publications

Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study

Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study

On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings

The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi

Contact Info

Product

Resources

About