Show simple item record

dc.contributor.authorNicholas, S
dc.contributor.authorPoulet, E
dc.contributor.authorWolters, L
dc.contributor.authorWapling, J
dc.contributor.authorRakesh, A
dc.contributor.authorAmoros, I
dc.contributor.authorSzumilin, E
dc.contributor.authorGueguen, M
dc.contributor.authorSchramm, B
dc.date.accessioned2019-10-27T18:47:20Z
dc.date.available2019-10-27T18:47:20Z
dc.date.issued2019-08-01
dc.date.submitted2019-10-25
dc.identifier.issn1758-2652
dc.identifier.pmid31441242
dc.identifier.doi10.1002/jia2.25387
dc.identifier.urihttp://hdl.handle.net/10144/619497
dc.description.abstractINTRODUCTION: Routinely monitoring the HIV viral load (VL) of people living with HIV (PLHIV) on anti-retroviral therapy (ART) facilitates intensive adherence counselling and faster ART regimen switch when treatment failure is indicated. Yet standard VL-testing in centralized laboratories can be time-intensive and logistically difficult in low-resource settings. This paper evaluates the outcomes of the first four years of routine VL-monitoring using Point-of-Care technology, implemented by Médecins Sans Frontières (MSF) in rural clinics in Malawi. METHODS: We conducted a retrospective cohort analysis of patients eligible for routine VL- testing between 2013 and 2017 in four decentralized ART-clinics and the district hospital in Chiradzulu, Malawi. We assessed VL-testing coverage and the treatment failure cascade (from suspected failure (first VL>1000 copies/mL) to VL suppression post regimen switch). We used descriptive statistics and multivariate logistic regression to assess factors associated with suspected failure. RESULTS AND DISCUSSION: Among 21,400 eligible patients, VL-testing coverage was 85% and VL suppression was found in 89% of those tested. In the decentralized clinics, 88% of test results were reviewed on the same day as blood collection, whereas in the district hospital the median turnaround-time for results was 85 days. Among first-line ART patients with suspected failure (N = 1544), 30% suppressed (VL<1000 copies/mL), 35% were treatment failures (confirmed by subsequent VL-testing) and 35% had incomplete VL follow-up. Among treatment failures, 80% (N = 540) were switched to a second-line regimen, with a higher switching rate in the decentralized clinics than in the district hospital (86% vs. 67%, p < 0.01) and a shorter median time-to-switch (6.8 months vs. 9.7 months, p < 0.01). Similarly, the post-switch VL-testing rate was markedly higher in the decentralized clinics (61% vs. 26%, p < 0.01). Overall, 79% of patients with a post-switch VL-test were suppressed. CONCLUSIONS: Viral load testing at the point-of-care in Chiradzulu, Malawi achieved high coverage and good drug regimen switch rates among those identified as treatment failures. In decentralized clinics, same-day test results and shorter time-to-switch illustrated the game-changing potential of POC-based VL-testing. Nevertheless, gaps were identified along all steps of the failure cascade. Regular staff training, continuous monitoring and creating demand are essential to the success of routine VL-testing.en_US
dc.language.isoenen_US
dc.publisherJohn Wiley & Sonsen_US
dc.rightsWith thanks to John Wiley & Sons.en_US
dc.subjectHIV
dc.subject90-90-90
dc.subjectDecentralization
dc.subjectHIV Care Continuum
dc.subjectHealth System Strengthening
dc.subjectTreatment failure
dc.subjectTreatment monitoring
dc.titlePoint-of-care viral load monitoring: outcomes from a decentralized HIV programme in Malawi.en_US
dc.identifier.journalJournal of the International AIDS Societyen_US
dc.source.journaltitleJournal of the International AIDS Society
refterms.dateFOA2019-10-27T18:47:20Z


Files in this item

Thumbnail
Name:
Nicholas et al 2019 Point-of-care ...
Size:
504.9Kb
Format:
PDF

This item appears in the following Collection(s)

Show simple item record