“After viral load testing, I get my results so I get to know which path my life is taking me”: qualitative insights on routine centralized and point-of-care viral load testing in western Kenya from the Opt4Kids and Opt4Mamas studies

Qian, Shirley Rui W; Hassan, Shukri A; Scallon, Andrea J; Oyaro, Patrick; Brown, Evelyn; Wagude, James; Mukui, Irene; Kinywa, Eunice; Oluoch, Frederick; Odhiambo, Francesca; Oyaro, Boaz; Kingwara, Leonard; Yongo, Nashon; Karauki, Enericah; Gao, Jody; Otieno, Lindah; John‐Stewart, Grace; Abuogi, Lisa; Patel, Rena C

doi:10.1186/s12913-022-08593-z

Cited by 6 publications

(6 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…By having closer POC DRT facilities to the spoke facilities than the national laboratory, this issue of batching delay is overcome by a network that includes POC DRT hubs. Since direct data about the impact of POC DRT testing on results utilisation have not been studied, parallels with POC VL testing may be useful: although POC VL testing has not necessarily consistently improved viral suppression,21 46–48 improved turnaround times are highly motivating for providers and patients49 and result utilisation appears to improve as well 20 47 50…”

Section: Discussionmentioning

confidence: 99%

Optimising HIV drug resistance testing laboratory networks in Kenya: insights from systems engineering modelling

Wang,

Kingwara,

Wagner

et al. 2024

BMJ Open

Self Cite

View full text Add to dashboard Cite

BackgroundHIV drug resistance (DR) is a growing threat to the durability of current and future HIV treatment success. DR testing (DRT) technologies are very expensive and specialised, relying on centralised laboratories in most low and middle-income countries. Modelling for laboratory network with point-of-care (POC) DRT assays to minimise turnaround time (TAT), is urgently needed to meet the growing demand.MethodsWe developed a model with user-friendly interface using integer programming and queueing theory to improve the DRT system in Kisumu County, Kenya. We estimated DRT demand based on both current and idealised scenarios and evaluated a centralised laboratory-only network and an optimised POC DRT network. A one-way sensitivity analysis of key user inputs was conducted.ResultsIn a centralised laboratory-only network, the mean TAT ranged from 8.52 to 8.55 working days, and the system could not handle a demand proportion exceeding 1.6%. In contrast, the mean TAT for POC DRT network ranged from 1.13 to 2.11 working days, with demand proportion up to 4.8%. Sensitivity analyses showed that expanding DRT hubs reduces mean TAT substantially while increasing the processing rate at national labs had minimal effect. For instance, doubling the current service rate at national labs reduced the mean TAT by only 0.0%–1.9% in various tested scenarios, whereas doubling the current service rate at DRT hubs reduced the mean TAT by 37.5%–49.8%. In addition, faster batching modes and transportation were important factors influencing the mean TAT.ConclusionsOur model offers decision-makers an informed framework for improving the DRT system using POC in Kenya. POC DRT networks substantially reduce mean TAT and can handle a higher demand proportion than a centralised laboratory-only network, especially for children and pregnant women living with HIV, where there is an immediate push to use DRT results for patient case management.

show abstract

Section: Discussionmentioning

confidence: 99%

Optimising HIV drug resistance testing laboratory networks in Kenya: insights from systems engineering modelling

Wang,

Kingwara,

Wagner

et al. 2024

BMJ Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…A study that combined POC VL with a differentiated service delivery strategy resulted in enhanced VS by 10.3% and retention by 7.7% among South African adults living with HIV [26]. Ultimately, despite some studies showing no efficacy, enthusiasm for POC VL testing exists not only among patients and providers, but also among policymakers at the national and international levels [18,32,40]. Future research needs to help elucidate cost-effective ways for when best to For intervention group participants, POC VL testing was intended to be performed at each study visit, which were targeted for every 12 weeks.…”

Section: Discussionmentioning

confidence: 99%

Impact of point‐of‐care HIV viral load and targeted drug resistance mutation testing on viral suppression among Kenyan pregnant and postpartum women: results from a prospective cohort study (Opt4Mamas)

Patel,

Oyaro,

Thomas

et al. 2023

J Int AIDS Soc.

Self Cite

View full text Add to dashboard Cite

IntroductionLack of viral suppression (VS) among pregnant and breastfeeding women living with HIV poses challenges for maternal and infant health, and viral load (VL) monitoring via centralized laboratory systems faces many barriers. We aimed to determine the impact of point‐of‐care (POC) VL and targeted drug resistance mutation (DRM) testing in improving VS among pregnant and postpartum women on antiretroviral therapy.MethodsWe conducted a pre/post‐intervention prospective cohort study among 820 pregnant women accessing HIV care at five public‐sector facilities in western Kenya from 2019 to 2022. The pre‐intervention or “control” group consisted of standard‐of‐care (SOC) centralized VL testing every 6 months and the post‐intervention or “intervention” group consisted of a combined strategy of POC VL every 3 months, targeted DRM testing, and clinical management support. The primary outcome was VS (VL ≤1000 copies/ml) at 6 months postpartum; secondary outcomes included uptake and turnaround times for VL testing and sustained VS.ResultsAt 6 months postpartum, 321/328 (98%) of participants in the intervention group and 339/347 (98%) in the control group achieved VS (aRR 1.00, 95% confidence interval [CI] 0.98, 1.02). When assessing VS using a threshold of <40 copies/ml, VS proportions were lower overall (90−91%) but remained similar between groups. Among women with viraemia (VL>1000 copies/ml) who underwent successful DRM testing in the intervention group, all (46/46, 100%) had some DRMs and 20 (43%) had major DRMs (of which 80% were nucleos(t)ide reverse transcriptase inhibitor mutations). POC VL testing uptake was high (>89%) throughout pregnancy, delivery, and postpartum periods, with a median turnaround time of 1 day (IQR 1, 4) for POC VL in the intervention group and 7 days (IQR 5, 9) for SOC VL in the control group. Sustained VS throughout follow‐up was similar between groups with either POC or SOC VL testing (90−91% for <1000 copies/ml, 62–70% for <40 copies/ml).ConclusionsOur combined strategy markedly decreased turnaround time but did not increase VS rates, which were already very high, or sustained VS among pregnant and postpartum women living with HIV. Further research on how best to utilize POC VL and DRM testing is needed to optimize sustained VS among this population.

show abstract

“…The interview guides covered the following domains: (1) barriers and facilitators to ART usage and VS, (2) VL literacy and experiences with SOC VL and DRM testing in regular care, (3) experiences with POC VL and DRM testing within the study, and (4) how to scale up both SOC and POC DRM and VL testing for programmatic use. For this analysis we focused on DRM testing aspects of the KIIs; for findings relevant to VL testing, please reference a related publication [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

“I feel drug resistance testing allowed us to make an informed decision”: qualitative insights on the role of HIV drug resistance mutation testing among children and pregnant women living with HIV in western Kenya

Scallon,

Hassan,

Qian

et al. 2023

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background Pregnant women and children living with HIV in Kenya achieve viral suppression (VS) at lower rates than other adults. While many factors contribute to these low rates, the acquisition and development of HIV drug resistance mutations (DRMs) are a contributing factor. Recognizing the significance of DRMs in treatment decisions, resource-limited settings are scaling up national DRM testing programs. From provider and patient perspectives, however, optimal ways to operationalize and scale-up DRM testing in such settings remain unclear. Methods Our mixed methods study evaluates the attitudes towards, facilitators to, and barriers to DRM testing approaches among children and pregnant women on antiretroviral therapy (ART) in five HIV treatment facilities in Kenya. We conducted 68 key informant interviews (KIIs) from December 2019 to December 2020 with adolescents, caregivers, pregnant women newly initiating ART or with a high viral load, and providers, laboratory/facility leadership, and policy makers. Our KII guides covered the following domains: (1) DRM testing experiences in routine care and through our intervention and (2) barriers and facilitators to routine and point-of-care DRM testing scale-up. We used inductive coding and thematic analysis to identify dominant themes with convergent and divergent subthemes. Results The following themes emerged from our analysis: (1) DRM testing and counseling were valuable to clinical decision-making and reassuring to patients, with timely results allowing providers to change patient ART regimens faster; (2) providers and policymakers desired an amended and potentially decentralized DRM testing process that incorporates quicker sample-to-results turn-around-time, less burdensome procedures, and greater patient and provider “empowerment” to increase comfort with testing protocols; (3) facility-level delays, deriving from overworked facilities and sample tracking difficulties, were highlighted as areas for improvement. Conclusions DRM testing has the potential to considerably improve patient health outcomes. Key informants recognized several obstacles to implementation and desired a more simplified, time-efficient, and potentially decentralized DRM testing process that builds provider comfort and confidence with DRM testing protocols. Further investigating the implementation, endurance, and effectiveness of DRM testing training is critical to addressing the barriers and areas of improvement highlighted in our study. Trial Registration NCT03820323.

show abstract

“After viral load testing, I get my results so I get to know which path my life is taking me”: qualitative insights on routine centralized and point-of-care viral load testing in western Kenya from the Opt4Kids and Opt4Mamas studies

Cited by 6 publications

References 36 publications

Optimising HIV drug resistance testing laboratory networks in Kenya: insights from systems engineering modelling

Optimising HIV drug resistance testing laboratory networks in Kenya: insights from systems engineering modelling

Impact of point‐of‐care HIV viral load and targeted drug resistance mutation testing on viral suppression among Kenyan pregnant and postpartum women: results from a prospective cohort study (Opt4Mamas)

“I feel drug resistance testing allowed us to make an informed decision”: qualitative insights on the role of HIV drug resistance mutation testing among children and pregnant women living with HIV in western Kenya

Contact Info

Product

Resources

About