Globally, less than half of all people living with HIV (PLHIV) have achieved viral suppression. Delays with laboratory testing in resource-limited settings continue to present challenges for monitoring treatment with antiretroviral therapy (ART).
Paul Drain, MD, MPH, an Assistant Professor in the UW Department of Global Health, is first author on a recent study that found that point-of-care (POC) testing and same day counseling by nurses significantly improved suppression of the virus, retention in care, and referral into community-based care.
POC testing allows important test results to be received by both the patient and clinician in a timely manner.
Set in Durban, South Africa, the study randomized patients into receiving either standard laboratory HIV viral load testing or POC viral load testing. Among 390 patients enrolled (195 per arm), 90% of POC tested and 76% of laboratory tested patients were retained and achieved viral suppression after 12 months, a statistically significant 13.9% increase.
The results of the study suggest a promising future for POC HIV viral load testing to simplify health care and improve outcomes for PLHIV receiving ART. Increasing access to POC HIV viral load testing could be a major step towards achieving UNAIDS’s 90-90-90 targets by 2020, especially in resource-limited areas such as South Africa.
"In our intervention arm we use point-of-care HIV viral testing, so this is doing the viral load testing within the clinic on the same day that the patient comes in," Dr. Drain said. "If there was a problem with the viral load – meaning if the viral load was high, we could do same-day counseling and try and address the issues or if we needed to switch them on to a second life regimen we could do that in an accelerated fashion."
The results of the study, “Point-of-Care Viral Load Testing Improves HIV Viral Suppression and Retention in Care,” were announced in a press conference Monday and presented in full on Tuesday, March 5, 2019, at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle, Washington.
The study was conducted by the Simplifying HIV TREAtment and Monitoring (STREAM) study team, a collaboration between University of Washington and the Centre for the AIDS Programme of Research in South Africa (CAPRISA).