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Giang JH, Basha G, Thomas KK, Oyaro P, Chohan BH, Kingwara L, Hassan SA, Yongo N, Wagude J, Oluoch F, Odhiambo F, Oyaro B, John-Stewart GC, Abuogi LL, Patel RC. Real-world performance of point-of-care vs. standard-of-care HIV viral load testing in western Kenya: Secondary analysis of Opt4Kids and Opt4Mamas studies. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003378. [PMID: 38913630 PMCID: PMC11195974 DOI: 10.1371/journal.pgph.0003378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/30/2024] [Indexed: 06/26/2024]
Abstract
Routine HIV viral load testing is important for evaluating HIV treatment outcomes, but conventional viral load testing has many barriers including expensive laboratory equipment and lengthy results return times to patients. A point-of-care viral load testing technology, such as GeneXpert HIV-1 quantification assay, could reduce these barriers by decreasing cost and turnaround time, however real-world performance is limited. We conducted a secondary analysis using 900 samples collected from participants in two studies to examine the performance of GeneXpert as point-of-care viral load compared to standard-of-care testing (which was conducted with two centralized laboratories using traditional HIV-1 RNA PCR quantification assays). The two studies, Opt4Kids (n = 704 participants) and Opt4Mamas (n = 820 participants), were conducted in western Kenya from 2019-2021 to evaluate the effectiveness of a combined intervention strategy, which included point-of-care viral load testing. Paired viral load results were compared using four different thresholds for virological non-suppression, namely ≥50, ≥200, ≥400, ≥1000 copies/ml. At a threshold of ≥1000 copies/mL, paired samples collected on the same day: demonstrated sensitivities of 90.0% (95% confidence interval [CI] 68.3, 98.8) and 66.7% (9.4, 99.2), specificities of 98.4% (95.5, 99.7) and 100% (96.5, 100), and percent agreements of 97.7% (94.6, 99.2) and 99.1% (95.0, 100) in Opt4Kids and Opt4Mamas studies, respectively. When lower viral load thresholds were used and the paired samples were collected an increasing number of days apart, sensitivity, specificity, and percent agreement generally decreased. While specificity and percent agreement were uniformly high, sensitivity was lower than expected. Non-specificity of the standard of care testing may have been responsible for the sensitivity values. Nonetheless, our results demonstrate that GeneXpert may be used reliably to monitor HIV treatment in low- and middle- income countries to attain UNAID's 95-95-95 HIV goals.
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Affiliation(s)
- Jessica H. Giang
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Garoma Basha
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Katherine K. Thomas
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Bhavna H. Chohan
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Leonard Kingwara
- National HIV Reference Laboratory, Kenya Ministry of Health, Nairobi, Kenya
| | - Shukri A. Hassan
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | | | | | | | - Francesca Odhiambo
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | - Boaz Oyaro
- Kenya Medical Research Institute-CDC, Kisian, Kenya
| | - Grace C. John-Stewart
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Departments of Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Lisa L. Abuogi
- Department of Pediatrics, University of Colorado, Denver, Colorado, United States of America
| | - Rena C. Patel
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Han WM, Broom J, Bopage R, Templeton DJ, Edmiston N, Petoumenos K. Investigating rates and predictors of viral blips, low-level viraemia and virological failure in the Australian HIV observational database. Trop Med Int Health 2024; 29:42-56. [PMID: 38009461 PMCID: PMC11108647 DOI: 10.1111/tmi.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
OBJECTIVES Australia has made significant progress towards achieving the UNAIDS's 95-95-95 cascade targets including HIV viral suppression. To investigate the burden of HIV viraemia, we assessed viral blips, low-level viraemia (LLV) and virologic failure (VF) in an Australian cohort. METHODS We studied the proportion of people with viral suppression, viral blips, LLV and VF in the Australian HIV observational database (AHOD) between 2010 and 2021. The association between blips or LLV, and VF was investigated using Cox regression, and predictors of viral blips and LLV were assessed using repeated-measured logistic regression. RESULTS Among 2544 AHOD participants who were in follow-up and on antiretroviral therapy (ART) from 1 January 2010 (88.7% male), 444 had experienced VF (incidence rate: 2.45 [95% CI: 2.23-2.69] per 100 person-years [PY]) during 18,125 PY of follow-up (a median of 7.6 years). The proportion of people with VF decreased over time, whereas rates of blips and LLV remained stable. Participants with blips (hazard ratio, 2.89; 95% CI: 2.31-3.61) and LLV (4.46; 95% CI: 3.38-5.89) were at increased risk of VF. Hepatitis B co-infection, longer documented treatment interruption duration, younger age and lower CD4 at ART initiation, and protease inhibitors-based initial regimen were associated with an increased risk of VF. Common predictors of blips and LLV such as higher HIV-1 RNA and lower CD4 at ART initiation, longer treatment interruption, more VL testing and types of care settings (hospitals vs. sexual health services) were identified. CONCLUSIONS Blips and LLV predict subsequent VF development. We identified important predictors of HIV viraemia including VF among individuals on INSTI-based regimens to help direct HIV management plans.
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Affiliation(s)
- Win Min Han
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Jennifer Broom
- Infectious Diseases Research Network, Sunshine Coast University Hospital, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Rohan Bopage
- Western Sydney Sexual Health Centre and Westmead Clinical School, University of Sydney, Australia
| | - David J Templeton
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, Camperdown, Australia
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Natalie Edmiston
- School of Medicine, Western Sydney University, Sydney, Australia
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Nakyanzi A, Naddunga F, Bulterys MA, Mujugira A, Wyatt MA, Kamusiime B, Nalumansi A, Kasiita V, Peacock S, Celum CL, Ware NC. " It Soothes Your Heart": A Multimethod Study Exploring Acceptability of Point-of-Care Viral Load Testing among Ugandan Pregnant and Postpartum Women Living with HIV. Diagnostics (Basel) 2023; 14:72. [PMID: 38201381 PMCID: PMC10795616 DOI: 10.3390/diagnostics14010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND High adherence to antiretroviral therapy (ART) is critical for achieving viral suppression and preventing onward HIV transmission. ART continuation can be challenging for pregnant women living with HIV (PWLHIV), which has critical implications for risk of vertical HIV transmission. Point-of-care viral load (POC VL) testing has been associated with improved treatment and retention outcomes. We sought to explore acceptability of POC VL testing among Ugandan PWLHIV during pregnancy and postpartum. METHODS This multimethod analysis drew on quantitative and qualitative data collected between February and December 2021. Quantitatively, we used an intent-to-treat analysis to assess whether randomization to clinic-based POC VL testing during pregnancy and infant testing at delivery was associated with improved viral suppression (≤50 copies/mL) by 3 months postpartum compared to standard-of-care (SOC) VL testing through a central laboratory, adjusting for factorial randomization for the male partner testing strategy. Additionally, a subset of 22 PWLHIV in the POC VL arm participated in in-depth qualitative interviews. We inductively analyzed transcripts to develop categories representing concepts that characterized women's perceptions of POC VL testing during pregnancy and at delivery and ways that POC VL testing may have impacted their ART adherence and viral suppression. Key themes around women's perceptions of POC VL testing were then organized into main categories. RESULTS Overall, 151 PWLHIV were enrolled into the study, 77 (51%) of whom were randomized to receive POC VL testing during pregnancy and at delivery. Women reported in qualitative interviews that POC VL testing had (1) motivated their ART adherence during pregnancy and postpartum and that they felt this testing method had (2) helped them protect their infants from acquiring HIV and (3) improved their emotional wellbeing. CONCLUSIONS POC VL testing was highly acceptable among Ugandan PWLHIV and was viewed as an important tool that women believed improved their ART adherence, gave them information necessary to protect their infants from vertical HIV acquisition, and improved their emotional wellbeing. These findings support the global scale-up of POC VL testing in settings with high HIV burden, especially for PWLHIV who may be at risk of treatment disruptions or loss to follow-up.
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Affiliation(s)
- Agnes Nakyanzi
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Faith Naddunga
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Michelle A. Bulterys
- Department of Global Health, University of Washington, Seattle, WA 98109, USA; (M.A.B.); (S.P.); (C.L.C.)
| | - Andrew Mujugira
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
- Department of Global Health, University of Washington, Seattle, WA 98109, USA; (M.A.B.); (S.P.); (C.L.C.)
| | - Monique A. Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.A.W.); (N.C.W.)
- Harvard Global, Cambridge, MA 02138, USA
| | - Brenda Kamusiime
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Alisaati Nalumansi
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Vicent Kasiita
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Sue Peacock
- Department of Global Health, University of Washington, Seattle, WA 98109, USA; (M.A.B.); (S.P.); (C.L.C.)
| | - Connie L. Celum
- Department of Global Health, University of Washington, Seattle, WA 98109, USA; (M.A.B.); (S.P.); (C.L.C.)
- Departments of Medicine and Epidemiology, University of Washington, Seattle, WA 98109, USA
| | - Norma C. Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.A.W.); (N.C.W.)
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
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Chang C, Agbaji O, Mitruka K, Olatunde B, Sule H, Dajel T, Zee A, Ahmed ML, Ahmed I, Okonkwo P, Chaplin B, Kanki P. Clinical Outcomes in a Randomized Controlled Trial Comparing Point-of-Care With Standard Human Immunodeficiency Virus (HIV) Viral Load Monitoring in Nigeria. Clin Infect Dis 2023; 76:e681-e691. [PMID: 35867672 PMCID: PMC11150517 DOI: 10.1093/cid/ciac605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Point-of-care (POC) viral load (VL) tests provide results within hours, enabling same-day treatment interventions. We assessed treatment outcomes with POC vs standard-of-care (SOC) VL monitoring. METHODS We implemented a randomized controlled trial at an urban and rural hospital in Nigeria. Participants initiating antiretroviral therapy (ART) were randomized 1:1 for monitoring via the POC Cepheid Xpert or SOC Roche COBAS (v2.0) HIV-1 VL assays. Viral suppression (VS) and retention in care at 12 months were compared via intention-to-treat (ITT) and per-protocol (PP) analyses. Post-trial surveys for POC patients and healthcare workers (HCWs) evaluated acceptability. RESULTS During April 2018-October 2019, 268 SOC and 273 POC patients enrolled in the trial. Viral suppression at <1000 copies/mL at 12 months was 59.3% (162/273) for POC and 52.2% (140/268) for SOC (P = .096) in ITT analysis and 77.1% (158/205) for POC and 65.9% (137/208) for SOC (P = .012) in PP analysis. Retention was not significantly different in ITT analysis but was 85.9% for POC and 76.9% for SOC (P = .02) in PP analysis. The increased VS in the POC arm was attributable to improved retention and documentation of VL results. POC monitoring was preferred over SOC by 90.2% (147/163) of patients and 100% (15/15) of HCWs thought it facilitated patient care. CONCLUSIONS POC VL monitoring did not improve 12-month VS among those with results but did improve retention and VS documentation and was preferred by most patients and HCWs. Further research can inform best POC implementation conditions and approaches to optimize patient care. CLINICAL TRIALS REGISTRATION NCT03533868.
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Affiliation(s)
- Charlotte Chang
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Oche Agbaji
- Jos University Teaching Hospital, Jos, Nigeria
| | - Kiren Mitruka
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Halima Sule
- Jos University Teaching Hospital, Jos, Nigeria
| | - Titus Dajel
- Comprehensive Health Centre Zamko, Jos, Nigeria
| | - Aaron Zee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Isah Ahmed
- APIN Public Health Initiatives, Abuja, Nigeria
| | | | - Beth Chaplin
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Phyllis Kanki
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Boyce RM, Ndizeye R, Ngelese H, Baguma E, Shem B, Rubinstein RJ, Rockwell E, Lotspeich SC, Shook-Sa BE, Ntaro M, Nyehangane D, Wohl DA, Siedner MJ, Mulogo EM. It takes more than a machine: A pilot feasibility study of point-of-care HIV-1 viral load testing at a lower-level health center in rural western Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001678. [PMID: 36972208 PMCID: PMC10042348 DOI: 10.1371/journal.pgph.0001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/29/2023] [Indexed: 03/29/2023]
Abstract
Barriers continue to limit access to viral load (VL) monitoring across sub-Saharan Africa adversely impacting control of the HIV epidemic. The objective of this study was to determine whether the systems and processes required to realize the potential of rapid molecular technology are available at a prototypical lower-level (i.e., level III) health center in rural Uganda. In this open-label pilot study, participants underwent parallel VL testing at both the central laboratory (i.e., standard of care) and on-site using the GeneXpert HIV-1 assay. The primary outcome was the number of VL tests completed each clinic day. Secondary outcomes included the number of days from sample collection to receipt of result at clinic and the number of days from sample collection to patient receipt of the result. From August 2020 to July 2021, we enrolled a total of 242 participants. The median number of daily tests performed on the Xpert platform was 4, (IQR = 2-7). Time from sample collection to result was 51 days (IQR = 45-62) for samples sent to the central laboratory and 0 days (IQR = 0-0.25) for the Xpert assay conducted at the health center. However, few participants elected to receive results by one of the expedited options, which contributed to similar time-to-patient between testing approaches (89 versus 84 days, p = 0.07). Implementation of a rapid, near point-of-care VL assay at a lower-level health center in rural Uganda appears feasible, but interventions to promote rapid clinical response and influence patient preferences about result receipt require further study. Trial registration: ClinicalTrials.gov Identifier: NCT04517825, Registered 18 August 2020. Available at: https://clinicaltrials.gov/ct2/show/NCT04517825.
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Affiliation(s)
- Ross M Boyce
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ronnie Ndizeye
- Faculty of Medicine, Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Herbert Ngelese
- Faculty of Medicine, Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Emmanuel Baguma
- Faculty of Medicine, Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Bwambale Shem
- Bugoye Level III Health Center, Uganda Ministry of Health, Kasese District, Uganda
| | - Rebecca J Rubinstein
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Emmanuel Rockwell
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sarah C Lotspeich
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Moses Ntaro
- Faculty of Medicine, Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Dan Nyehangane
- Epicentre Mbarara Research Centre, Mbarara, Uganda
- Faculty of Medicine, Department of Medical Laboratory Science, Mbarara University of Science & Technology, Mbarara, Uganda
| | - David A Wohl
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mark J Siedner
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Edgar M Mulogo
- Faculty of Medicine, Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
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Tun NN, Smithuis F, Tun NL, Min M, Hlaing MMM, Olmen JV, Lynen L, Gils T. Near point-of-care HIV viral load testing: Cascade after high viral load in suburban Yangon, Myanmar. PLoS One 2023; 18:e0272673. [PMID: 37053171 PMCID: PMC10101411 DOI: 10.1371/journal.pone.0272673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/10/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION HIV viral load (VL) testing in resource-limited settings is often centralised, limiting access. In Myanmar, we assessed outcomes according to VL access and the VL cascade (case management after a first high VL result) before and after near point-of-care (POC) VL was introduced. METHODS Routine programme data from people living with HIV (PLHIV) on antiretroviral therapy (ART) were used. We assessed the odds of getting a VL test done by year. Attrition and mortality two years after ART initiation were compared between three groups of PLHIV with different access to VL testing using Kaplan-Meier analysis. We compared VL cascades in those with a first VL result before and after near POC VL testing became available. With logistic regression, predictors of confirmed virological failure after a first high VL in the POC era were explored. RESULTS Among 4291 PLHIV who started ART between July 2009 and June 2018, 794 (18.5%) became eligible for VL testing when it was not available, 2388 (55.7%) when centralised laboratory-based VL testing was available, and 1109 (25.8%) when near POC VL testing was available. Between 2010 and 2019, the odds of getting a VL test among those eligible increased with each year (OR: 5.21 [95% CI: 4.95-5.48]). Attrition and mortality were not different in the three groups. When comparing PLHIV with a first VL result before and after implementation of the near POC VL testing, in the latter, more had a first VL test (92% versus 15%, p<0.001), less had a first high VL result (5% versus 14%, p<0.001), and more had confirmed virological failure (67% versus 47%, p = 0.013). Having a first VL ≥5000 copies/mL after near POC implementation was associated with confirmed virological failure (adjusted OR: 2.61 [95% CI: 1.02-6.65]). CONCLUSION Near POC VL testing enabled rapid increase of VL coverage and a well-managed VL cascade in Myanmar.
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Affiliation(s)
- Ni Ni Tun
- HIV/TB, Medical Action Myanmar, Yangon, Myanmar
- HIV/TB, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Frank Smithuis
- HIV/TB, Medical Action Myanmar, Yangon, Myanmar
- HIV/TB, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Nyan Lynn Tun
- HIV/TB, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Myo Min
- HIV/TB, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | | | - Josefien van Olmen
- Spearhead Research Public Health & Primary Care, University of Antwerp, Antwerp, Belgium
| | - Lutgarde Lynen
- Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tinne Gils
- Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Ochodo EA, Olwanda EE, Deeks JJ, Mallett S. Point-of-care viral load tests to detect high HIV viral load in people living with HIV/AIDS attending health facilities. Cochrane Database Syst Rev 2022; 3:CD013208. [PMID: 35266555 PMCID: PMC8908762 DOI: 10.1002/14651858.cd013208.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Viral load (VL) testing in people living with HIV (PLHIV) helps to monitor antiretroviral therapy (ART). VL is still largely tested using central laboratory-based platforms, which have long test turnaround times and involve sophisticated equipment. VL tests with point-of-care (POC) platforms capable of being used near the patient are potentially easy to use, give quick results, are cost-effective, and could replace central or reference VL testing platforms. OBJECTIVES To estimate the diagnostic accuracy of POC tests to detect high viral load levels in PLHIV attending healthcare facilities. SEARCH METHODS We searched eight electronic databases using standard, extensive Cochrane search methods, and did not use any language, document type, or publication status limitations. We also searched the reference lists of included studies and relevant systematic reviews, and consulted an expert in the field from the World Health Organization (WHO) HIV Department for potentially relevant studies. The latest search was 23 November 2020. SELECTION CRITERIA We included any primary study that compared the results of a VL test with a POC platform to that of a central laboratory-based reference test to detect high viral load in PLHIV on HIV/AIDS care or follow-up. We included all forms of POC tests for VL as defined by study authors, regardless of the healthcare facility in which the test was conducted. We excluded diagnostic case-control studies with healthy controls and studies that did not provide sufficient data to create the 2 × 2 tables to calculate sensitivity and specificity. We did not limit our study inclusion to age, gender, or geographical setting. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles, abstracts, and full texts of the search results to identify eligible articles. They also independently extracted data using a standardized data extraction form and conducted risk of bias assessment using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Using participants as the unit of analysis, we fitted simplified univariable models for sensitivity and specificity separately, employing a random-effects model to estimate the summary sensitivity and specificity at the current and commonly reported World Health Organization (WHO) threshold (≥ 1000 copies/mL). The bivariate models did not converge to give a model estimate. MAIN RESULTS We identified 18 studies (24 evaluations, 10,034 participants) defining high viral loads at main thresholds ≥ 1000 copies/mL (n = 20), ≥ 5000 copies/mL (n = 1), and ≥ 40 copies/mL (n = 3). All evaluations were done on samples from PLHIV retrieved from routine HIV/AIDS care centres or health facilities. For clinical applicability, we included 14 studies (20 evaluations, 8659 participants) assessing high viral load at the clinical threshold of ≥ 1000 copies/mL in the meta-analyses. Of these, sub-Saharan Africa, Europe, and Asia contributed 16, three, and one evaluation respectively. All included participants were on ART in only nine evaluations; in the other 11 evaluations the proportion of participants on ART was either partial or not clearly stated. Thirteen evaluations included adults only (n = 13), five mixed populations of adults and children, whilst in the remaining two the age of included populations was not clearly stated. The majority of evaluations included commercially available tests (n = 18). Ten evaluations were POC VL tests conducted near the patient in a peripheral or onsite laboratory, whilst the other 10 were evaluations of POC VL tests in a central or reference laboratory setting. The test types evaluated as POC VL tests included Xpert HIV-1 Viral Load test (n = 8), SAMBA HIV-1 Semi-Q Test (n = 9), Alere Q NAT prototype assay for HIV-1 (n = 2) and m-PIMA HIV-1/2 Viral Load test (n = 1). The majority of evaluations (n = 17) used plasma samples, whilst the rest (n = 3) utilized whole blood samples. Pooled sensitivity (95% confidence interval (CI)) of POC VL at a threshold of ≥ 1000 copies/mL was 96.6% (94.8 to 97.8) (20 evaluations, 2522 participants), and pooled specificity (95% CI) was 95.7% (90.8 to 98.0) (20 evaluations, 6137 participants). Median prevalence for high viral load (≥ 1000 copies/mL) (n = 20) was 33.4% (range 6.9% to 88.5%). Limitations The risk of bias was mostly assessed as unclear across the four domains due to incomplete reporting. AUTHORS' CONCLUSIONS We found POC VL to have high sensitivity and high specificity for the diagnosis of high HIV viral load in PLHIV attending healthcare facilities at a clinical threshold of ≥ 1000 copies/mL.
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Affiliation(s)
- Eleanor A Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Mallett
- UCL Centre for Medical Imaging, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
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Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications. Ann Glob Health 2022; 88:16. [PMID: 35433287 PMCID: PMC8916058 DOI: 10.5334/aogh.3532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sher M, Coleman B, Caputi M, Asghar W. Development of a Point-of-Care Assay for HIV-1 Viral Load Using Higher Refractive Index Antibody-Coated Microbeads. SENSORS 2021; 21:s21051819. [PMID: 33807789 PMCID: PMC7961362 DOI: 10.3390/s21051819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022]
Abstract
The detection of viruses using imaging techniques is challenging because of the weak scattering of light generated by the targets of sizes in the nanometer range. The system we have developed overcomes the light scattering problems by utilizing antibody-coated microbeads of higher index of refraction that can specifically bind with viruses and increase the acceptance angle. Using the new technology, we have developed a portable, cost-effective, and field-deployable platform for the rapid quantification of HIV-1 viral load for point-of-care (POC) settings. The system combines microfluidics with a wide field of view lensless imaging technology. Highly specific antibodies are functionalized to a glass slide inside a microchip to capture HIV-1 virions. The captured virions are then bound by antibody-conjugated microbeads, which have a higher refraction index. The microbeads-HIV-1 virions complexes generate diffraction patterns that are detected with a custom-built imaging setup and rapidly and accurately quantified by computational analysis. This platform technology enables fast nanoscale virus imaging and quantification from biological samples and thus can play a significant role in the detection and management of viral diseases.
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Affiliation(s)
- Mazhar Sher
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA;
- Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Benjamin Coleman
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA;
| | - Massimo Caputi
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Waseem Asghar
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431, USA;
- Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
- Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL 33431, USA
- Correspondence:
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Bulterys MA, Oyaro P, Brown E, Yongo N, Karauki E, Wagude J, Kingwara L, Bowen N, Njogo S, Wagner AD, Mukui I, Oluoch F, Abuogi L, Patel R, Sharma M. Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya. Diagnostics (Basel) 2021; 11:140. [PMID: 33477850 PMCID: PMC7832863 DOI: 10.3390/diagnostics11010140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The number of people living with HIV (PLHIV) in need of treatment monitoring in low-and-middle-income countries is rapidly expanding, straining existing laboratory capacity. Point-of-care viral load (POC VL) testing can alleviate the burden on centralized laboratories and enable faster delivery of results, improving clinical outcomes. However, implementation costs are uncertain and will depend on clinic testing volume. We sought to estimate the costs of decentralized POC VL testing compared to centralized laboratory testing for adults and children receiving HIV care in Kenya. METHODS We conducted microcosting to estimate the per-patient costs of POC VL testing compared to known costs of centralized laboratory testing. We completed time-and-motion observations and stakeholder interviews to assess personnel structures, staff time, equipment costs, and laboratory processes associated with POC VL administration. Capital costs were estimated using a 5 year lifespan and a 3% annual discount rate. RESULTS We estimated that POC VL testing cost USD $24.25 per test, assuming a clinic is conducting 100 VL tests per month. Test cartridge and laboratory equipment costs accounted for most of the cost (62% and 28%, respectively). Costs varied by number of VL tests conducted at the clinic, ranging from $54.93 to $18.12 per test assuming 20 to 500 VL tests per month, respectively. A VL test processed at a centralized laboratory was estimated to cost USD $25.65. CONCLUSION POC VL testing for HIV treatment monitoring can be feasibly implemented in clinics within Kenya and costs declined with higher testing volumes. Our cost estimates are useful to policymakers in planning resource allocation and can inform cost-effectiveness analyses evaluating POC VL testing.
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Affiliation(s)
- Michelle Ann Bulterys
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
| | - Patrick Oyaro
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
- Health Innovations Kenya, Kisumu, Kenya
| | - Evelyn Brown
- Department of HIV Research, University of Washington Kenya, Nairobi, Kenya; (E.B.); (N.Y.); (E.K.)
| | - Nashon Yongo
- Department of HIV Research, University of Washington Kenya, Nairobi, Kenya; (E.B.); (N.Y.); (E.K.)
| | - Enericah Karauki
- Department of HIV Research, University of Washington Kenya, Nairobi, Kenya; (E.B.); (N.Y.); (E.K.)
| | | | - Leonard Kingwara
- National HIV Reference Laboratory, National Public Health Laboratory, Nairobi, Kenya; (L.K.); (N.B.); (F.O.)
| | - Nancy Bowen
- National HIV Reference Laboratory, National Public Health Laboratory, Nairobi, Kenya; (L.K.); (N.B.); (F.O.)
| | - Susan Njogo
- National AIDS and STI Control Programme, Ministry of Health, Nairobi 19361, Kenya;
| | - Anjuli D. Wagner
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
| | - Irene Mukui
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
| | - Frederick Oluoch
- National HIV Reference Laboratory, National Public Health Laboratory, Nairobi, Kenya; (L.K.); (N.B.); (F.O.)
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA;
| | - Rena Patel
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98105, USA
| | - Monisha Sharma
- Departments of Epidemiology and Global Health, University of Washington, Seattle, WA 98105, USA; (P.O.); (A.D.W.); (I.M.); (R.P.); (M.S.)
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