Sustainable HIV Treatment in Africa Through Viral-Load-Informed Differentiated Care

Hdl Handle:
http://hdl.handle.net/10144/618882
Title:
Sustainable HIV Treatment in Africa Through Viral-Load-Informed Differentiated Care
Authors:
Phillips, A; Shroufi, A; Vojnov, L; Cohn, J; Roberts, T; Ellman, T; Bonner, K; Rousseau, C; Garnett, G; Cambiano, V; Nakagawa, F; Ford, D; Bansi-Matharu, L; Miners, A; Lundgren, JD; Eaton, JW; Parkes-Ratanshi, R; Katz, Z; Maman, D; Ford, N; Vitoria, M; Doherty, M; Dowdy, D; Nichols, B; Murtagh, M; Wareham, M; Palamountain, KM; Chakanyuka Musanhu, C; Stevens, W; Katzenstein, D; Ciaranello, A; Barnabas, R; Braithwaite, RS; Bendavid, E; Nathoo, KJ; van de Vijver, D; Wilson, DP; Holmes, C; Bershteyn, A; Walker, S; Raizes, E; Jani, I; Nelson, LJ; Peeling, R; Terris-Prestholt, F; Murungu, J; Mutasa-Apollo, T; Hallett, TB; Revill, P
Journal:
Nature
Abstract:
There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.
Publisher:
Nature Publishing Group
Issue Date:
3-Dec-2015
URI:
http://hdl.handle.net/10144/618882
DOI:
10.1038/nature16046
PubMed ID:
26633768
Submitted date:
2017-03-30
Language:
en
ISSN:
1476-4687
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorPhillips, Aen
dc.contributor.authorShroufi, Aen
dc.contributor.authorVojnov, Len
dc.contributor.authorCohn, Jen
dc.contributor.authorRoberts, Ten
dc.contributor.authorEllman, Ten
dc.contributor.authorBonner, Ken
dc.contributor.authorRousseau, Cen
dc.contributor.authorGarnett, Gen
dc.contributor.authorCambiano, Ven
dc.contributor.authorNakagawa, Fen
dc.contributor.authorFord, Den
dc.contributor.authorBansi-Matharu, Len
dc.contributor.authorMiners, Aen
dc.contributor.authorLundgren, JDen
dc.contributor.authorEaton, JWen
dc.contributor.authorParkes-Ratanshi, Ren
dc.contributor.authorKatz, Zen
dc.contributor.authorMaman, Den
dc.contributor.authorFord, Nen
dc.contributor.authorVitoria, Men
dc.contributor.authorDoherty, Men
dc.contributor.authorDowdy, Den
dc.contributor.authorNichols, Ben
dc.contributor.authorMurtagh, Men
dc.contributor.authorWareham, Men
dc.contributor.authorPalamountain, KMen
dc.contributor.authorChakanyuka Musanhu, Cen
dc.contributor.authorStevens, Wen
dc.contributor.authorKatzenstein, Den
dc.contributor.authorCiaranello, Aen
dc.contributor.authorBarnabas, Ren
dc.contributor.authorBraithwaite, RSen
dc.contributor.authorBendavid, Een
dc.contributor.authorNathoo, KJen
dc.contributor.authorvan de Vijver, Den
dc.contributor.authorWilson, DPen
dc.contributor.authorHolmes, Cen
dc.contributor.authorBershteyn, Aen
dc.contributor.authorWalker, Sen
dc.contributor.authorRaizes, Een
dc.contributor.authorJani, Ien
dc.contributor.authorNelson, LJen
dc.contributor.authorPeeling, Ren
dc.contributor.authorTerris-Prestholt, Fen
dc.contributor.authorMurungu, Jen
dc.contributor.authorMutasa-Apollo, Ten
dc.contributor.authorHallett, TBen
dc.contributor.authorRevill, Pen
dc.date.accessioned2017-03-31T18:43:14Z-
dc.date.available2017-03-31T18:43:14Z-
dc.date.issued2015-12-03-
dc.date.submitted2017-03-30-
dc.identifier.citationSustainable HIV Treatment in Africa Through Viral-Load-Informed Differentiated Care. 2015, 528 (7580):S68-76 Natureen
dc.identifier.issn1476-4687-
dc.identifier.pmid26633768-
dc.identifier.doi10.1038/nature16046-
dc.identifier.urihttp://hdl.handle.net/10144/618882-
dc.description.abstractThere are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.en
dc.language.isoenen
dc.publisherNature Publishing Groupen
dc.rightsArchived on this site with permission from Macmillan Publishers Ltd. Copyright 200Xen
dc.subjectviral loaden
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAfricaen
dc.subject.meshAgeden
dc.subject.meshAnti-HIV Agentsen
dc.subject.meshCost-Benefit Analysisen
dc.subject.meshHIV Infectionsen
dc.subject.meshHumansen
dc.subject.meshMiddle Ageden
dc.subject.meshPrecision Medicineen
dc.subject.meshViral Loaden
dc.subject.meshYoung Adulten
dc.titleSustainable HIV Treatment in Africa Through Viral-Load-Informed Differentiated Careen
dc.identifier.journalNatureen

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