The case for viral load testing in adolescents in resource‐limited settings

Abstract

Introduction The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low‐ and middle‐income settings, particularly in sub‐Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90‐90‐90 targets across the HIV care continuum, implementation is incomplete. We discuss the rationale for prioritizing viral load monitoring among adolescents and the associated challenges. Discussion Adolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second‐line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third‐line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens. Conclusions Given scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale‐up.

Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria

“…[55][56][57] Scale-up of routine VL testing is therefore necessary not only to allow providers make informed decisions on clinical management but also to encourage and sustain optimal engagement with care among AYLHIV. 58…”

Realizing the potential of routine viral load testing in sub‐Saharan Africa

“…Ellman et al discuss the optimal viral load threshold to use when defining virological failure [24], while Saito et al describe the unique experience of providing viral load results to individuals participating in the PHIA Project [25]. Specific issues related to viral load testing among pregnant women, infants and children, adolescents and selected key populations are described in articles by Lesosky et al [26], Arpadi et al [27], Marcus et al [28] and Schwartz et al [29] respectively. Finally, the article by Barnabas et al includes a systematic review of evidence related to the cost-effectiveness of routine viral load monitoring in low-and middle-income countries [30].…”

A Global Research Agenda for Adolescents Living With HIV

“…However, with the unreliable nature of self-reporting or pill counting and limited access to routine viral load monitoring, objective adherence monitoring remains difficult for programs. 23 , 24 This requires improved understanding of effective monitoring tools. In addition, drug-related strategies are imperative in optimizing treatment options and supporting lifelong adherence.…”