Progress with Scale-Up of HIV Viral Load Monitoring — Seven Sub-Saharan African Countries, January 2015–June 2016

Lecher, Shirley Lee; Williams, Jason D.; Fonjungo, Peter N.; Kim, Andrea A; Ellenberger, Dennis; Zhang, Guoqing; Toure, Christiane Adje; Agolory, Simon; Appiah-Pippim, Georgette; Beard, Suzanne; Borget, Marie Yolande; Carmona, Sergio; Chipungu, Geoffrey; Diallo, Karidia; Downer, Marie; Edgil, Dianna; Haberman, Holly; Hurlston, Mackenzie; Jadzak, Steven; Kiyaga, Charles; Macleod, W. Bentley; Makumb, Boniface; Muttai, Hellen; Mwangi, Christina; Mwangi, Jane; Mwasekaga, Michael; Naluguza, Mary; Ng’ang’a, Lucy; Nguyen, Shon; Sawadogo, Souleymane; Sleeman, Katrina; Stevens, Wendy; Kuritsky, Joel N.; Hader, Shannon; Nkengasong, John N.

doi:10.15585/mmwr.mm6547a2

Cited by 101 publications

(99 citation statements)

References 4 publications

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“…The discrepancy between the current recommendations for VL monitoring for all patients receiving ART and the insufficient capacity for VL testing constitutes a huge obstacle for ART programs in low-income countries, especially in view of the goal of achieving universal ART coverage among PLHIV [8,10,28]. Although resources for VL monitoring are being scaled up in high-burden countries [10,19] it is important to consider alternative evidence-based strategies to monitor patients on ART.…”

Section: Discussionmentioning

confidence: 99%

“…Although resources for VL monitoring are being scaled up in high-burden countries [10,19] it is important to consider alternative evidence-based strategies to monitor patients on ART. Algorithms that assess the likelihood of VF could help target resources for viral load testing in a cost-effective manner.…”

Section: Discussionmentioning

confidence: 99%

“…This achievement has been made possible by decentralisation and integration of HIV care into primary health care. In these settings, access to VL monitoring is severely restricted [10], and expansion of viral load capacities is hampered by high cost and technical requirements [11]. …”

Section: Introductionmentioning

confidence: 99%

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Development of an algorithm for determination of the likelihood of virological failure in HIV-positive adults receiving antiretroviral therapy in decentralized care

Reepalu

Balcha

Skogmar

et al. 2017

Global Health Action

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Background: Early identification of virological failure (VF) limits occurrence and spread of drug-resistant viruses in patients receiving antiretroviral treatment (ART). Viral load (VL) monitoring is therefore recommended, but capacities to comply with this are insufficient in many low-income countries. Clinical algorithms might identify persons at higher likelihood of VF to allocate VL resources. Objectives: We aimed to construct a VF algorithm (the Viral Load Testing Criteria; VLTC) and compare its performance to the 2013 WHO treatment failure criteria. Methods: Subjects with VL results available 1 year after ART start (n = 494) were identified from a cohort of ART-naïve adults (n = 812), prospectively recruited and followed 2011–2015 at Ethiopian health centres. VF was defined as VL≥1000 copies/mL. Variables recorded at the time of sampling, with potential association with VF, were used to construct the algorithm based on multivariate logistic regression. Results: Fifty-seven individuals (12%) had VF, which was independently associated with CD4 count <350 cells/mm3, previous ART interruption, and short mid-upper arm circumference (<24cm and <23cm, for men and women, respectively). These variables were included in the VLTC. In derivation, the VLTC identified 52/57 with VF; sensitivity 91%, specificity 43%, positive predictive value (PPV) 17%, negative predictive value (NPV) 97%. In comparison, the WHO criteria identified 38/57 with VF (sensitivity 67%, specificity 74%, PPV 25%, NPV 94%). Conclusions: The VLTC identified subjects at greater likelihood of VF, with higher sensitivity and NPV than the WHO criteria. If external validation confirms this performance, these criteria could be used to allocate limited VL resources. Due to its limited specificity, it cannot be used to determine treatment failure in the absence of a confirmatory viral load.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Development of an algorithm for determination of the likelihood of virological failure in HIV-positive adults receiving antiretroviral therapy in decentralized care

Reepalu

Balcha

Skogmar

et al. 2017

Global Health Action

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“…Coverage of VL testing in Namibia is quite high. At the end of 2016, MOHSS estimated that >90% of patients on ART had access to VL testing [7]. The rest of the patients were on ART at remote facilities that could not get plasma specimens transported to any of the NIP laboratories within a reasonable amount of time for VL testing.…”

Section: Methodsmentioning

confidence: 99%

Low Case Finding Among Men and Poor Viral Load Suppression Among Adolescents Are Impeding Namibia’s Ability to Achieve UNAIDS 90-90-90 Targets

Agolory¹,

Klerk²,

Baughman³

et al. 2018

Open Forum Infectious Diseases

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BackgroundIn 2015, Namibia implemented an Acceleration Plan to address the high burden of HIV (13.0% adult prevalence and 216 311 people living with HIV [PLHIV]) and achieve the UNAIDS 90-90-90 targets by 2020. We provide an update on Namibia’s overall progress toward achieving these targets and estimate the percent reduction in HIV incidence since 2010.MethodsData sources include the 2013 Namibia Demographic and Health Survey (2013 NDHS), the national electronic patient monitoring system, and laboratory data from the Namibian Institute of Pathology. These sources were used to estimate (1) the percentage of PLHIV who know their HIV status, (2) the percentage of PLHIV on antiretroviral therapy (ART), (3) the percentage of patients on ART with suppressed viral loads, and (4) the percent reduction in HIV incidence.ResultsIn the 2013 NDHS, knowledge of HIV status was higher among HIV-positive women 91.8% (95% confidence interval [CI], 89.4%–93.7%) than HIV-positive men 82.5% (95% CI, 78.1%–86.1%). At the end of 2016, an estimated 88.3% (95% CI, 86.3%–90.1%) of PLHIV knew their status, and 165 939 (76.7%) PLHIV were active on ART. The viral load suppression rate among those on ART was 87%, and it was highest among ≥20-year-olds (90%) and lowest among 15–19-year-olds (68%). HIV incidence has declined by 21% since 2010.ConclusionsWith 76.7% of PLHIV on ART and 87% of those on ART virally suppressed, Namibia is on track to achieve UNAIDS 90-90-90 targets by 2020. Innovative strategies are needed to improve HIV case identification among men and adherence to ART among youth.

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“…Viral load determination in dried blood spots rather than plasma can greatly increase access to information on viral load, especially in settings far from processing laboratories. Although there is some loss in sensitivity when using dried blood spots, it may be the preferable option given that viral load testing capacity is currently weak across sub-Saharan Africa (6,9).…”

Section: What Does the Future Hold?mentioning

confidence: 99%

Rolling out HIV antiretroviral therapy in sub-Saharan Africa: 2003–2017

Taylor

2018

Canada Communicable Disease Report

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Multiple issues need to be addressed in order to control the HIV pandemic in sub-Saharan Africa. Combination antiretroviral therapy (cART) is key to reducing morbidity and mortality among people living with HIV and has a role in preventing HIV transmission. However, access to cART is very unevenly distributed globally, especially in sub-Saharan Africa. Although cost of cART is no longer a major barrier as effective treatment can be had for under US$100 per year, HIV management is compromised by the inadequate number of trained clinicians, the lack of clinical and laboratory infrastructure and the increased prevalence of co-morbidities (e.g., tuberculosis).To address this disparity, a number of initiatives have been undertaken. One of these was the development of the Infectious Diseases Institute (IDI) at Makerere University, Kampala, Uganda. The goals of the IDI are the clinical care of people living with HIV, clinical research relevant to Uganda (in particular) and sub-Saharan Africa, and clinical training. My initial participation was as a trainer in a program to educate large numbers of clinicians in antiretroviral therapy and other aspects of HIV/AIDS management, with the intention that they become leaders of large clinical programs in their home communities.Major progress has been made in providing access to cART, and HIV/AIDS mortality and incidence of new cases is decreasing. Nertheless, to reach the World Health Organization 90-90-90 targets by 2020, there remains a need to expand services and develop novel approaches to HIV management. In addition to providing hands-on clinical care, Canadian health care providers can help by transferring clinical skills to local clinicians or by developing streamlined clinical paradigms or new technologies for long-term HIV management in resource-limited settings.

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Progress with Scale-Up of HIV Viral Load Monitoring — Seven Sub-Saharan African Countries, January 2015–June 2016

Cited by 101 publications

References 4 publications

Development of an algorithm for determination of the likelihood of virological failure in HIV-positive adults receiving antiretroviral therapy in decentralized care

Development of an algorithm for determination of the likelihood of virological failure in HIV-positive adults receiving antiretroviral therapy in decentralized care

Low Case Finding Among Men and Poor Viral Load Suppression Among Adolescents Are Impeding Namibia’s Ability to Achieve UNAIDS 90-90-90 Targets

Rolling out HIV antiretroviral therapy in sub-Saharan Africa: 2003–2017

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