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Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges

Despite immense progress in antiretroviral therapy (ART) scale-up, many people still lack access to basic standards of care, with our ability to meet the Joint United Nations Programme on HIV/AIDS 90-90-90 treatment targets for HIV/AIDS dependent on dramatic improvements in diagnostics. The World He...

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Autores principales: Roberts, Teri, Cohn, Jennifer, Bonner, Kimberly, Hargreaves, Sally
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803106/
https://www.ncbi.nlm.nih.gov/pubmed/26743094
http://dx.doi.org/10.1093/cid/ciw001
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author Roberts, Teri
Cohn, Jennifer
Bonner, Kimberly
Hargreaves, Sally
author_facet Roberts, Teri
Cohn, Jennifer
Bonner, Kimberly
Hargreaves, Sally
author_sort Roberts, Teri
collection PubMed
description Despite immense progress in antiretroviral therapy (ART) scale-up, many people still lack access to basic standards of care, with our ability to meet the Joint United Nations Programme on HIV/AIDS 90-90-90 treatment targets for HIV/AIDS dependent on dramatic improvements in diagnostics. The World Health Organization recommends routine monitoring of ART effectiveness using viral load (VL) testing at 6 months and every 12 months, to monitor treatment adherence and minimize failure, and will publish its VL toolkit later this year. However, the cost and complexity of VL is preventing scale-up beyond developed countries and there is a lack of awareness among clinicians as to the long-term patient benefits and its role in prolonging the longevity of treatment programs. With developments in this diagnostic field rapidly evolving—including the recent improvements for accurately using dried blood spots and the imminent appearance to the market of point-of-care technologies offering decentralized diagnosis—we describe current barriers to VL testing in resource-limited settings. Effective scale-up can be achieved through health system and laboratory system strengthening and test price reductions, as well as tackling multiple programmatic and funding challenges.
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spelling pubmed-48031062016-03-23 Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges Roberts, Teri Cohn, Jennifer Bonner, Kimberly Hargreaves, Sally Clin Infect Dis HIV/AIDS Despite immense progress in antiretroviral therapy (ART) scale-up, many people still lack access to basic standards of care, with our ability to meet the Joint United Nations Programme on HIV/AIDS 90-90-90 treatment targets for HIV/AIDS dependent on dramatic improvements in diagnostics. The World Health Organization recommends routine monitoring of ART effectiveness using viral load (VL) testing at 6 months and every 12 months, to monitor treatment adherence and minimize failure, and will publish its VL toolkit later this year. However, the cost and complexity of VL is preventing scale-up beyond developed countries and there is a lack of awareness among clinicians as to the long-term patient benefits and its role in prolonging the longevity of treatment programs. With developments in this diagnostic field rapidly evolving—including the recent improvements for accurately using dried blood spots and the imminent appearance to the market of point-of-care technologies offering decentralized diagnosis—we describe current barriers to VL testing in resource-limited settings. Effective scale-up can be achieved through health system and laboratory system strengthening and test price reductions, as well as tackling multiple programmatic and funding challenges. Oxford University Press 2016-04-15 2016-01-06 /pmc/articles/PMC4803106/ /pubmed/26743094 http://dx.doi.org/10.1093/cid/ciw001 Text en © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, contact journals.permissions@oup.com.
spellingShingle HIV/AIDS
Roberts, Teri
Cohn, Jennifer
Bonner, Kimberly
Hargreaves, Sally
Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges
title Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges
title_full Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges
title_fullStr Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges
title_full_unstemmed Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges
title_short Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges
title_sort scale-up of routine viral load testing in resource-poor settings: current and future implementation challenges
topic HIV/AIDS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803106/
https://www.ncbi.nlm.nih.gov/pubmed/26743094
http://dx.doi.org/10.1093/cid/ciw001
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