scholarly journals Evaluation of Two Techniques for Viral Load Monitoring Using Dried Blood Spot in Routine Practice in Vietnam (French National Agency for AIDS and Hepatitis Research 12338)

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Fabien Taieb ◽  
Tran Hong Tram ◽  
Hien Thi Ho ◽  
Van Anh Pham ◽  
Huong Lan Nguyen ◽  
...  
Keyword(s):  
Viral Load ◽  
Dried Blood Spot ◽  
World Health ◽  
Hiv Care ◽  
Routine Practice ◽  
National Agency ◽  
Resource Limited ◽  
Load Monitoring ◽  
Health Organization ◽  
Blood Spot

Abstract Background.  Although it is the best method to detect early therapeutic failure, viral load (VL) monitoring is still not widely available in many resource-limited settings because of difficulties in specimen transfer, personnel shortage, and insufficient laboratory infrastructures. Dried blood spot (DBS) use, which was introduced in the latest World Health Organization recommendations, can overcome these difficulties. This evaluation aimed at validating VL measurement in DBS, in a laboratory without previous DBS experience and in routine testing conditions. Methods.  Human immunodeficiency virus (HIV)-infected adults were observed in a HIV care site in Hanoi, and each patient provided 2 DBS cards with whole blood spots and 2 plasma samples. Viral load was measured in DBS and in plasma using the COBAS Ampliprep/TaqMan and the Abbott RealTime assays. To correctly identify those with VL ≥ 1000 copies/mL, sensitivity and specificity were estimated. Results.  A total of 198 patients were enrolled. With the Roche technique, 51 plasma VL were ≥1000 copies/mL; among these, 28 presented a VL in DBS that was also ≥1000 copies/mL (sensitivity, 54.9; 95% confidence interval [CI], 40.3–68.9). On the other hand, all plasma VL < 1000 copies/mL were also <1000 copies/mL in DBS (specificity, 100; 95% CI, 97.5–100). With the Abbott technique, 45 plasma VL were ≥1000 copies/mL; among these, 42 VL in DBS were also ≥1000 copies/mL (sensitivity, 93.3%; 95% CI, 81.7–98.6); specificity was 94.8 (95% CI, 90.0–97.7). Conclusions.  The Abbott RealTime polymerase chain reaction assay provided adequate VL results in DBS, thus allowing DBS use for VL monitoring.

scholarly journals Factors Associated with Outcomes of Pre-ART HIV Care

2018 ◽  
Vol 17 ◽  
pp. 232595821875960
Author(s):  
Kristen A. Stafford ◽  
Lucy W. Nganga ◽  
Tuhuma Tulli ◽  
Karen G. Fleischman Foreit
Keyword(s):  
Disease Progression ◽  
Opportunistic Infections ◽  
World Health ◽  
Hiv Care ◽  
Cox Models ◽  
Factors Associated ◽  
Art Initiation ◽  
Resource Limited ◽  
Health Organization ◽  
Lost To Follow Up

The World Health Organization recommended removing all CD4 requirements for initiation of antiretroviral therapy (ART) in resource-limited settings. We examined the pre-ART period to identify and assess factors associated with outcomes of pre-ART care. Four modes of transition out of pre-ART care were considered. Beta estimates from the competing risks Cox models were used to investigate whether the effects of covariates differed by mode of transition. Median CD4 counts at entry showed no meaningful change over time. Advanced disease progression and presence of opportunistic infections were significant predictors of pre-ART mortality. Men were more likely to die before initiating ART, transfer to another facility, or be lost to follow-up than were women. Removing CD4 thresholds is not likely to substantially reduce program mortality prior to ART initiation unless and until patients enroll earlier in disease progression. Care programs should focus on diagnosis and treatment of opportunistic infections to reduce pre-ART mortality.

scholarly journals The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Osman Abdullahi ◽  
Ngari Moses ◽  
Deche Sanga ◽  
Willetts Annie
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Clinical Signs ◽  
World Health ◽  
Routine Practice ◽  
Public And Private ◽  
Systematic Screening ◽  
Tb Treatment ◽  
Resource Limited ◽  
Health Organization

AbstractThe World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections.

HIV in Resource-Limited Settings

2019 ◽  
pp. 263-298
Author(s):  
John G. Bartlett ◽  
Robert R. Redfield ◽  
Paul A. Pham
Keyword(s):  
Diagnostic Tests ◽  
Opportunistic Infections ◽  
World Health ◽  
Hiv Care ◽  
Current Status ◽  
Who Guidelines ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Health Organization ◽  
Delivery Models

Abstract: This chapter reviews the diagnosis, assessment, testing, and treatment of HIV in resource-limited settings around the world. The chapter covers the current status of the HIV pandemic, diagnosis of HIV (i.e., who to test), HIV testing, HIV diagnostic tests, World Health Organization (WHO) guidelines and treatment recommendations, monitoring ART efficacy and toxicity, treatment and prophylaxis of opportunistic infections and other comorbid conditions, treatment of tuberculosis and cryptococcal meningitis, co-trimoxazole prophylaxis, HIV vaccines, differentiated service delivery models of HIV care, important global trials, and further recommended reading.

Using dried blood spot testing for diagnosing viral hepatitis

2020 ◽  
Vol 29 (20) ◽  
pp. 1155-1158
Author(s):  
Kathryn Jack ◽  
William Lucien Irving
Keyword(s):  
Hepatitis B ◽  
Viral Hepatitis ◽  
Public Health Problem ◽  
Dried Blood Spot ◽  
World Health ◽  
Populations At Risk ◽  
Health Organization ◽  
Sample Method ◽  
Drug And Alcohol ◽  
Blood Spot

The target set by the World Health Organization to eliminate viral hepatitis as a public health problem by 2030 first requires methods of testing for hepatitis B and C virus that are acceptable to diverse populations. One such test is the dried blood spot sample method. This article explains what a dried blood spot sample is, how it is collected, and how it can help increase the viral hepatitis test uptake in prisons, drug and alcohol services, and other populations at risk of hepatitis B or C infection.

scholarly journals Longitudinal Viral Load Monitoring Using Home-Collected Dried Blood Spot Specimens of MSM Living with HIV: Results from a Feasibility Pilot Study

2020 ◽  
Author(s):  
Richard A. Teran ◽  
Magdalena E. Sobieszczyk ◽  
Mary Ann Chiasson ◽  
Anne-Catrin Uhlemann ◽  
Jessica Weidler ◽  
...  
Keyword(s):  
Viral Load ◽  
Pilot Study ◽  
Dried Blood Spot ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Living With Hiv ◽  
Blood Spot

scholarly journals Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004–2012

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Donald J. Hamel ◽  
Jean-Louis Sankalé ◽  
Jay O. Samuels ◽  
Abdoulaye D. Sarr ◽  
Beth Chaplin ◽  
...  
Keyword(s):  
Viral Load ◽  
Scale Up ◽  
Hiv Treatment ◽  
Resource Limited Setting ◽  
World Health ◽  
Hiv Care ◽  
Future Health ◽  
Laboratory Capacity ◽  
Resource Limited ◽  
Limited Setting

Introduction: From 2004–2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President’s Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations.Methods: Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings.Results: Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories.Conclusions: Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings.

scholarly journals Sensitivity and specificity of two dried blood spot methods for HIV-1 viral load monitoring among patients in Hanoi, Vietnam

PLoS ONE ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. e0191411 ◽  
Author(s):  
Todd M. Pollack ◽  
Hao T. Duong ◽  
Phuong T. Truong ◽  
Thuy T. Pham ◽  
Cuong D. Do ◽  
...  
Keyword(s):  
Viral Load ◽  
Sensitivity And Specificity ◽  
Dried Blood Spot ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Hiv 1 ◽  
Blood Spot
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