Point-of-care viral load testing among adolescents and young adults living with HIV in Haiti: a randomized control trial

Reif, Lindsey K.; Belizaire, Marie Elmase; Rouzier, Vanessa; Seo, Grace; Sévère, Patrice; Joseph, Joseph-Marie Bajo; Joseph, Bernadette; Apollon, Sandra; Pape, Jean William; McNairy, Margaret L.; Elul, Batya; Fitzgerald, Daniel W.; Arpadi, Stephen M.; Abrams, Elaine J.; Kuhn, Louise

doi:10.1080/09540121.2021.1981816

Cited by 4 publications

(3 citation statements)

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“… 21 In this study, all participants were on first-line efavirenz-based regimens, there were few participants with viral failure (16 of 390, 4.1%), and the research team conducted clinical management in the intervention arm, meaning it is difficult to determine the contribution of point-of-care testing within the overall implementation strategy. Trials among children in Kenya, 17 adolescents in Haiti, 18 and adults in Nigeria 19 , 20 found that point-of-care VL testing improved time to receipt of VL results by 2, 4, and 20 weeks, respectively, with improved switching to second-line ART. However, none of these trials found a clear impact on viral suppression.…”

Section: Discussionmentioning

confidence: 99%

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Point-of-Care Viral Load Testing to Manage HIV Viremia During the Rollout of Dolutegravir-Based ART in South Africa: A Randomized Feasibility Study (POwER)

Dorward

Sookrajh

Lessells

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Data are required regarding the feasibility of conducting a randomized trial of point-of-care viral load (VL) testing to guide management of HIV viremia and to provide estimates of effect to guide potential future trial design. Setting: Two public South African clinics during the dolutegravir-based antiretroviral therapy (ART) rollout. Methods: We randomized adults receiving first-line ART, with recent VL ≥1000 copies/mL, in a 1:1 ratio to receive point-of-care Xpert HIV-1 VL versus standard-of-care laboratory VL testing after 12 weeks. Feasibility outcomes included proportions of eligible patients enrolled and completing follow-up and VL process outcomes. Estimates of effect were assessed using the trial primary outcome of VL <50 copies/mL after 24 weeks. Results: From August 2020 to March 2022, we enrolled 80 eligible participants, an estimated 24% of those eligible. 47 of 80 (58.8%) were women, and the median age was 38.5 years (interquartile range [IQR], 33–45). 44 of 80 (55.0%) were receiving dolutegravir, and 36 of 80 (465.0%) were receiving efavirenz. After 12 weeks, point-of-care participants received VL results after median 3.1 hours (IQR 2.6–3.8), versus 7 days (IQR 6–8, P < 0.001) in standard of care. Twelve-week follow-up VL was ≥1000 copies/mL in 13 of 39 (33.3%) point-of-care participants and in 16 of 41 (39.0%) standard-of-care participants; 11 of 13 (84.6%) and 12 of 16 (75.0%) switched to second-line ART. After 24 weeks, 76 of 80 (95.0%) completed follow-up. 27 of 39 (69.2% [95% CI: 53.4 to 81.4]) point-of-care participants achieved VL <50 copies/mL versus 29 of 40 (72.5% [57.0 to 83.9]) standard-of-care participants. Point-of-care participants had median 3 (IQR, 3–4) clinical visits versus 4 (IQR, 4–5) in standard-of-care participants (P < 0.001). Conclusions: It was feasible to conduct a trial of point-of-care VL testing to manage viremia. Point-of-care VL lead to quicker results and fewer clinical visits, but estimates of 24-week VL suppression were similar between arms. Trial Registration: Pan African Clinical Trials Registry: PACTR202001785886049.

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Section: Discussionmentioning

confidence: 99%

“…To date, 2 point-of-care assays have been approved as accurate by the WHO for use in LMICs 13,14 and have been evaluated in our setting. 15,16 Clinical trials of these assays among children, 17 adolescents, 18 and adults [19][20][21] have demonstrated shorter turnaround times, but effects on clinical outcomes have been mixed.…”

Section: Introductionmentioning

confidence: 99%

Point-of-Care Viral Load Testing to Manage HIV Viremia During the Rollout of Dolutegravir-Based ART in South Africa: A Randomized Feasibility Study (POwER)

Dorward

Sookrajh

Lessells

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…La mayor demanda de pruebas de CV-VIH ha contribuido a la demora en los resultados, afectando las terapias de recuperación y su adherencia (Gous et al, 2018). Este problema crea la necesidad de plataformas dinámicas para atender la demanda de la población con resultados oportunos, como es el caso del equipo del GeneXpert (Reif et al, 2021;Zamboni Berra et al, 2021). La incorporación de nuevos sistemas reduciría el tiempo de respuesta, los procesos y el costo; aumentando la eficacia y eficiencia del laboratorio (Curioso, 2020).…”

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Impacto en el monitoreo de carga viral de VIH en el laboratorio del Hospital Nacional Sergio E. Bernales 2019-2021

2023

BMSA

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The objective of this study was to determine the impact of monitoring the HIV viral load in the Laboratory of the Sergio E. Bernales National Hospital during the period 2019 to 2021. A descriptive, quantitative, observational, retrospective, comparative, and analytical study was carried out. We worked with 490 patients who had follow-up viral load. The findings revealed a predominance of males with 64% of HIV cases and 36% of females. During the monitoring period, 14.9% of the patients were admitted as new HIV cases, while 8% started antiretroviral treatment (ART). Regarding the viral load results, 14.9% of the patients had a viral load greater than 1000 copies/ml, 5 patients had between 200 and 1000 cp/ml. 70 patients had a viral load greater than 40 to ≤ 1000 cp/mL, 173 patients had a viral load less than 40 cp/mL, and 174 patients had an undetectable viral load. At the end of the monitoring study, a statistical significance of 0.00 and a Pearson correlation coefficient of 0.450 were found, indicating a weak to moderate correlation between the final viral load and the monitoring result. These findings highlight the crucial importance of timely monitoring of viral load in patients with HIV. It was evidenced that 38.3% of the patients who had adequate viral load follow-up achieved viral suppression, 43.5% maintained viral suppression, 14.9% experienced virological failure, and 1% presented resistant viremia.

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Interventions to Improve Adolescent HIV Care Outcomes

Mulawa¹,

Knippler²,

Al-Mujtaba³

et al. 2023

Curr HIV/AIDS Rep

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Point-of-care viral load testing among adolescents and young adults living with HIV in Haiti: a randomized control trial

Cited by 4 publications

References 32 publications

Point-of-Care Viral Load Testing to Manage HIV Viremia During the Rollout of Dolutegravir-Based ART in South Africa: A Randomized Feasibility Study (POwER)

Point-of-Care Viral Load Testing to Manage HIV Viremia During the Rollout of Dolutegravir-Based ART in South Africa: A Randomized Feasibility Study (POwER)

Impacto en el monitoreo de carga viral de VIH en el laboratorio del Hospital Nacional Sergio E. Bernales 2019-2021

Interventions to Improve Adolescent HIV Care Outcomes

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