scholarly journals Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245085
Author(s):  
Tichaona Mapangisana ◽  
Rhoderick Machekano ◽  
Vinie Kouamou ◽  
Caroline Maposhere ◽  
Kathy McCarty ◽  
...  
Keyword(s):  
Viral Load ◽  
Children And Adolescents ◽  
Virologic Failure ◽  
Sub Saharan Africa ◽  
Virologic Suppression ◽  
Second Line ◽  
Load Testing ◽  
Viral Load Suppression ◽  
Viral Load Testing

Introduction Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe. Methods From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver’s characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU). Results At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8–15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001). Conclusion Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.

scholarly journals Performance and Outcomes of Routine Viral Load Testing in People Living with HIV Newly Initiating ART in the Integrated HIV Care Program in Myanmar between January 2016 and December 2017

2020 ◽  
Vol 5 (3) ◽  
pp. 140
Author(s):  
Sai Soe Thu Ya ◽  
Anthony D. Harries ◽  
Khin Thet Wai ◽  
Nang Thu Thu Kyaw ◽  
Thet Ko Aung ◽  
...  
Keyword(s):  
Viral Load ◽  
Virologic Failure ◽  
Secondary Data ◽  
Care Program ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Second Line ◽  
Load Testing ◽  
One Year ◽  
Living With Hiv

Myanmar has introduced routine viral load (VL) testing for people living with HIV (PLHIV) starting first-line antiretroviral therapy (ART). The first VL test was initially scheduled at 12-months and one year later this changed to 6-months. Using routinely collected secondary data, we assessed program performance of routine VL testing at 12-months and 6-months in PLHIV starting ART in the Integrated HIV-Care Program, Myanmar, from January 2016 to December 2017. There were 7153 PLHIV scheduled for VL testing at 12-months and 1976 scheduled for VL testing at 6-months. Among those eligible for testing, the first VL test was performed in 3476 (51%) of the 12-month cohort and 952 (50%) of the 6-month cohort. In the 12-month cohort, 10% had VL > 1000 copies/mL, 79% had repeat VL tests, 42% had repeat VL > 1000 copies/mL (virologic failure) and 85% were switched to second-line ART. In the 6-month cohort, 11% had VL > 1000 copies/mL, 83% had repeat VL tests, 26% had repeat VL > 1000 copies/mL (virologic failure) and 39% were switched to second-line ART. In conclusion, half of PLHIV initiated on ART had VL testing as scheduled at 12-months or 6-months, but fewer PLHIV in the 6-month cohort were diagnosed with virologic failure and switched to second-line ART. Programmatic implications are discussed.

scholarly journals Non-uptake of viral load testing among people receiving HIV treatment in Gomba district, rural Uganda

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rita Nakalega ◽  
Nelson Mukiza ◽  
George Kiwanuka ◽  
Ronald Makanga-Kakumba ◽  
Robert Menge ◽  
...  
Keyword(s):  
Viral Load ◽  
Virologic Failure ◽  
Treatment Success ◽  
Cross Sectional Study ◽  
Hiv Treatment ◽  
Virologic Suppression ◽  
Load Testing ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Art Initiation

Abstract Background Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda. Methods We conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome). Results Of 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31–48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14–55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37–4.12; p = 0.002), younger age 16–30 years (AOR 2.74; 95% CI:1.44–5.24; p = 0.002) and 31–45 years (AOR 1.92; 95% CI 1.12–3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78–4.56; p < 0.001) were significantly associated with non-uptake of VL testing. Conclusions One-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95–95-95 target – virologic suppression for 95% of PWH on ART.

Results of a Physician Survey on Ordering Viral Load Testing

2003 ◽  
Vol 127 (4) ◽  
pp. 446-450
Author(s):  
Louise K. Hofherr ◽  
Diane P. Francis ◽  
J. Rex Astles ◽  
William O. Schalla
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Infectious Diseases ◽  
Load Test ◽  
Self Report ◽  
Patient Treatment ◽  
Load Testing ◽  
Viral Load Testing ◽  
Immunodeficiency Virus

Abstract Objective.—To profile physicians' practices, utilization, and understanding of human immunodeficiency virus type 1 RNA (viral load) testing and the laboratory's role in this testing. Design.—Cross sectional study using a 34-item self-report survey mailed to physicians identified as requesting viral load testing, with follow-up mailings to nonresponders. Participants.—A sampling of US physicians specializing in infectious diseases, internal medicine, and family practice associated with high, medium, and low human immunodeficiency virus/acquired immunodeficiency syndrome incidence areas. Results.—Most respondents using viral load results were infectious diseases specialists practicing in urban areas. The reasons most frequently given for requesting viral load testing were (1) to assist in patient follow-up or monitoring (75.4%), and (2) to initiate/guide therapy (62.5%). Respondents indicated that the interpretation and use of viral load results presented difficulty in the areas of patient treatment and in determining what change from baseline was clinically significant. Few respondents used the testing laboratory pathologist as a resource for interpreting viral load test results. Conclusions.—Our study indicates that physicians have questions about (1) the meaning of viral load tests, (2) how often to monitor the viral load, and (3) what change from baseline of the viral load is significant. Few physicians avail themselves of the expertise available in the laboratory for testing viral loads and interpreting such results.

Evaluating Patients for Second-Line Antiretroviral Therapy in India: The Role of Targeted Viral Load Testing

2010 ◽  
Vol 55 (5) ◽  
pp. 610-614 ◽  
Author(s):  
Bharat B Rewari ◽  
Damodar Bachani ◽  
Sikhamani Rajasekaran ◽  
Alaka Deshpande ◽  
Po Lin Chan ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Second Line ◽  
Load Testing ◽  
Viral Load Testing ◽  
Second Line Antiretroviral Therapy

scholarly journals Point-of-Care Viral Load Testing for Sub-Saharan Africa: Informing a Target Product Profile

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Andrew N. Phillips ◽  
Valentina Cambiano ◽  
Fumiyo Nakagawa ◽  
Deborah Ford ◽  
Tsitsi Apollo ◽  
...  
Keyword(s):  
Viral Load ◽  
Point Of Care ◽  
Sub Saharan Africa ◽  
Load Testing ◽  
Viral Load Testing ◽  
Trade Offs ◽  
Art Program ◽  
Product Profile ◽  
Load Tests ◽  
Sub Saharan

Abstract Point-of-care viral load tests are being developed to monitor patients on antiretroviral therapy (ART) in sub-Saharan Africa. Test design involves trade-offs between test attributes, including accuracy, complexity, robustness, and cost. We used a model of the human immunodeficiency virus epidemic and ART program in Zimbabwe and found that the attributes of a viral load testing approach that are most influential for cost effectiveness are avoidance of a high proportion of failed tests or results not received, use of an approach that best facilitates retention on ART, and the ability to facilitate greater use of differentiated care, including through expanding coverage of testing availability.

scholarly journals Resource and infrastructure challenges on the RESIST-2 Trial: an implementation study of drug resistance genotype-based algorithmic ART switches in HIV-2-infected adults in Senegal

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dana N. Raugi ◽  
Khardiata Diallo ◽  
Mouhamadou Baïla Diallo ◽  
Dominique Faye ◽  
Ousseynou Cisse ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Viral Load ◽  
Virologic Failure ◽  
Resistance Testing ◽  
Second Line ◽  
Implementation Challenges ◽  
Drug Resistance Testing ◽  
Inhibitor Resistance ◽  
Drug Resistance Genotype

Abstract Background Second-line treatment of HIV-2 in resource-limited settings (RLS) is complicated by a lack of controlled trial data, limited availability of HIV-2-active antiretroviral drugs, and inadequate access to drug resistance testing. We conducted an implementation trial of a dried blood spot- (DBS) based, drug resistance genotype-informed antiretroviral therapy (ART) switching algorithm for HIV-2-infected patients in Senegal. Methods HIV-2-infected adults initiating or receiving ART through the Senegalese national AIDS program were invited to participate in this single-arm trial. DBS from participants with virologic failure (defined as viral load (VL) > 250 copies/mL after > 6 months on the current ART regimen) were shipped to Seattle for genotypic drug resistance testing. Participants with evidence of drug resistance in protease or reverse transcriptase were switched to new regimens according to a pre-specified algorithm. Participant clinical and immuno-virologic outcomes were assessed, as were implementation challenges. Results We enrolled 152 participants. Ten were initiating ART. The remainder were ART-experienced, with 91.0% virologically suppressed (< 50 copies/mL). Problems with viral load testing capability resulted in obtaining VL results for only 227 of 613 (37.0%) participant-visits. Six of 115 participants (5.2%) with VL available after > 6 months on current ART regimen experienced virologic failure, with per-protocol genotypic testing attempted. One additional test was performed for a participant with a VL of 222 copies/mL. Genotypes from three participants showed no evidence of major drug resistance mutations, two showed nucleoside reverse transcriptase inhibitor (NRTI) resistance, one showed both NRTI and protease inhibitor resistance, and one test failed. No integrase inhibitor resistance was observed. Five of six successfully-tested participants switched to the correct regimen or received additional adherence counseling according to the algorithm; the sixth was lost to follow-up. Follow-up VL testing was available for two participants; both of these were virally suppressed (< 10 copies/mL). The trial was terminated early due to the COVID-19 pandemic (which prevented further VL and genotypic testing), planned rollout of dolutegravir-based 1st-line ART, and funding. Conclusions The RESIST-2 trial demonstrated that a DBS-based genotypic test can be used to help inform second-line ART decisions as part of a programmatic algorithm in RLS, albeit with significant implementation challenges. Trial registration ClinicalTrials.govNCT03394196. Registered on January 9, 2018.

scholarly journals Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time?

2013 ◽  
Vol 7 (08) ◽  
pp. 593-599
Author(s):  
María Eugenia Socías ◽  
Flavio Rotryng ◽  
Pablo Lapadula ◽  
Maira Medrano ◽  
Daniela Paz ◽  
...  
Keyword(s):  
Viral Load ◽  
Virologic Failure ◽  
Laboratory Data ◽  
Treatment As Prevention ◽  
Viral Load Suppression ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Third Line ◽  
Over Time

Introduction: Recently, there has been increasing interest in the role of “treatment as prevention” (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting. Methodology: We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs. Results: Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12–15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007). Conclusions:  Maintaining viral load suppression over time in resource-limited-settings is feasible.

scholarly journals How do different eligibility guidelines for antiretroviral therapy affect the cost–effectiveness of routine viral load testing in sub-Saharan Africa?

AIDS ◽  
2014 ◽  
Vol 28 ◽  
pp. S73-S83 ◽  
Author(s):  
Ronald Scott Braithwaite ◽  
Kimberly A. Nucifora ◽  
Christopher Toohey ◽  
Jason Kessler ◽  
Lauren M. Uhler ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Antiretroviral Therapy ◽  
Sub Saharan Africa ◽  
Load Testing ◽  
Viral Load Testing ◽  
Sub Saharan ◽  
The Cost

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

2020 ◽  
Vol 18 ◽  
pp. 100231
Author(s):  
Giovanni Villa ◽  
Adam Abdullahi ◽  
Dorcas Owusu ◽  
Colette Smith ◽  
Marilyn Azumah ◽  
...  
Keyword(s):  
Viral Load ◽  
Care Setting ◽  
Point Of Care ◽  
Virological Suppression ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Load Testing ◽  
Viral Load Testing ◽  
Sub Saharan

scholarly journals Prevalence of Nonsuppressed Viral Load and Associated Factors Among Adults Receiving Antiretroviral Therapy in Eswatini, Lesotho, Malawi, Zambia, and Zimbabwe (2015-2017): Results from Population-Based Nationally-Representative Surveys

2020 ◽  
Author(s):  
Andreas D Haas ◽  
Elizabeth Radin ◽  
Avi J Hakim ◽  
Andreas Jahn ◽  
Neena Philip ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Virologic Failure ◽  
Scale Up ◽  
Female Gender ◽  
Antiretroviral Drugs ◽  
People Living With Hiv ◽  
Second Line ◽  
Viral Load Suppression ◽  
Factors Associated

Introduction: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a target of ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) to have viral load suppression (VLS). We examined factors associated with nonsuppressed viral Load (NVL). Methods: We included PLHIV receiving ART aged 15-59 years from Eswatini, Lesotho, Malawi, Zambia, and Zimbabwe. Blood samples from PLHIV were analyzed for HIV RNA and recent exposure to antiretroviral drugs (ARVs). Outcomes were NVL (viral load ≥1000 copies/mL), virologic failure (VF; ARVs present and viral load ≥1000 copies/mL), interrupted ART (ARVs absent and viral load ≥1000 copies/mL), and receiving second-line ART. We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second-line ART. Results: The prevalence of NVL was 11.2%: 8.2% experienced VF, and 3.0% interrupted ART. Younger age, male gender, less education, suboptimal adherence, receiving nevirapine, HIV non-disclosure, never having married, and residing in Zimbabwe, Lesotho, or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female gender, shorter ART duration, higher CD4 count, and alcohol use were associated with higher odds for interrupted ART and lower odds for VF. Many people with VF (44.8%) had CD4 counts <200 cells/μL, but few (0.31% per year) switched to second-line ART. Conclusions: Countries are approaching UNAIDS VLS targets for adults. Treatment support for people initiating ART with asymptomatic HIV infection, scale-up of viral load monitoring, and optimized ART regimens may further reduce NVL prevalence.

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