Point-of-care tests poised to alter course of HIV treatment

Laursen, Lucas

doi:10.1038/nm0812-1156

Cited by 16 publications

(13 citation statements)

References 1 publication

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“…Point‐of‐care testing (POCT) has shown great potential for disease diagnosis, drug dosage control and physiological state monitoring because it is rapid, inexpensive and straightforward . Sampling biofluids is the first and essential step for POCT and blood serum and plasma are the most often used biofluids since they are rich in metabolites, which can provide important information of health situation .…”

Section: Introductionmentioning

confidence: 99%

A Hydrogel Microneedle Patch for Point‐of‐Care Testing Based on Skin Interstitial Fluid

Niu

et al. 2020

Adv Healthcare Materials

168

149

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Skin interstitial fluid (ISF) holds great potential as a highly desirable sample resource for point‐of‐care testing (POCT), where the key is to effectively collect target biomarkers from ISF. Hydrogel microneedle patch has great promise for ISF extraction. However, it is challenging to recover target biomarkers from the extracted skin ISF in hydrogel microneedle patches in an easy‐administrated, fast, and bulky instrument‐free manner. Herein, a hydrogel microneedle patch made of polyvinyl alcohol (PVA) and chitosan (CS) for POCT based on the ISF is developed. The phase transition property of PVA/CS hydrogel makes the microneedles stiff when dry, which is beneficial to easily penetrate into skin. Meanwhile, the highly porous microstructure of hydrogel offers good swelling ability for extraction of ISF and the thermal degradation property of PVA makes it convenient to quickly and efficiently recover target biomarkers from microneedle patch. The capability of this platform for POCT applications is further demonstrated by successful detections of typical biomarkers collected from the mimetic skin and monitoring the glucose level in rabbit skins during a day. The developed hydrogel microneedle patch holds the advantages of extraction of skin ISF and recovery of biomarkers, thus presenting as a powerful platform for skin ISF‐based POCT applications.

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Section: Introductionmentioning

confidence: 99%

A Hydrogel Microneedle Patch for Point‐of‐Care Testing Based on Skin Interstitial Fluid

Niu

et al. 2020

Adv Healthcare Materials

168

149

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“…Centralized testing with dried blood spots (DBS), is a practical and efficient VL-testing method, with the drawback of often lengthy result turnaround-time (TAT) [23][24][25][26][27]. Point-of-Care (POC)-technology offers an attractive alternative that provides same-day results for clinical decisions by bringing testing directly to the facility [16,[18][19][20]24,[28][29][30][31][32][33]. Today, several POC-VL technologies are in the pipeline or are becoming more accessible for low-resource settings [34].…”

Section: Introductionmentioning

confidence: 99%

Point‐of‐care viral load monitoring: outcomes from a decentralized HIV programme in Malawi

Nicholas¹,

Poulet²,

Wolters³

et al. 2019

J Intern AIDS Soc

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Introduction 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...

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“…PCR amplification and real-time fluorescence detection are performed using a small, bench-top analyzer. 11,12 The turnaround time is approximately 1 hour, and the test is performed in the study clinic.…”

Section: Methods and Designmentioning

confidence: 99%

“…11,12 Results are available within 1 hour, which allows reporting of results on the same day. Clinical performance of the Alere q was recently validated in Mozambique in a study that included heel-stick samples from 827 HIV-exposed infants.…”

Section: Introductionmentioning

confidence: 99%

Point-of-Care Virologic Testing to Improve Outcomes of HIV-Infected Children in Zambia: A Clinical Trial Protocol

Chibwesha

Ford

Mollan

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction:In the absence of early infant diagnosis (EID) and immediate antiretroviral therapy (ART), some 50% of untreated HIV-infected infants die before age 2. Conventional EID requires sophisticated instruments that are typically placed in centralized or reference laboratories. In low-resource settings, centralized systems often lead to result turnaround times of several months, long delays in diagnosis, and adverse outcomes for HIV-infected children. Our clinical trial tests the effectiveness of a new point-of-care (POC) diagnostic technology to identify HIV-infected infants and start providing them life-saving ART as soon as possible.Methods and Design:The study uses a randomized, controlled design to test whether the Alere q platform for HIV DNA polymerase chain reaction (PCR) testing improves outcomes of HIV-infected children in Zambia. We aim to enroll 2867 HIV-exposed infants aged 4–12 weeks and to follow those who are HIV infected for 12 months as they receive HIV care at 6 public health facilities in Lusaka. The trial's primary endpoint is the proportion of HIV-infected infants in each study arm who start ART and remain alive, in care, and virally suppressed 12 months after their diagnostic blood draw.Discussion:Our trial will provide evidence for the incremental benefit of implementing a POC EID strategy in low-resource settings where only off-site PCR services are currently available. The results will be useful in guiding future decisions regarding investments in POC virologic testing as part of overall pediatric AIDS mitigation strategies in sub-Saharan Africa.Trial Registration:clinicaltrials.gov NCT02682810.

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Point-of-care tests poised to alter course of HIV treatment

Cited by 16 publications

References 1 publication

A Hydrogel Microneedle Patch for Point‐of‐Care Testing Based on Skin Interstitial Fluid

A Hydrogel Microneedle Patch for Point‐of‐Care Testing Based on Skin Interstitial Fluid

Point‐of‐care viral load monitoring: outcomes from a decentralized HIV programme in Malawi

Point-of-Care Virologic Testing to Improve Outcomes of HIV-Infected Children in Zambia: A Clinical Trial Protocol

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