Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa.



Villa, Giovanni, Abdullahi, Adam ORCID: 0000-0001-9703-8264, Owusu, Dorcas, Smith, Colette, Azumah, Marilyn, Sayeed, Laila, Austin, Harrison, Awuah, Dominic, Beloukas, Apostolos ORCID: 0000-0001-5639-0528, Chadwick, David
et al (show 2 more authors) (2020) Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa. EClinicalMedicine, 18.

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Abstract

Background: This prospective pilot study explored same-day point-of-care viral load testing in a setting in Ghana that has yet to implement virological monitoring of antiretroviral therapy (ART). Methods: Consecutive patients accessing outpatient care while on ART underwent HIV-1 RNA quantification by Xpert. Those with viraemia at the first measurement (T0) received immediate adherence counselling and were reassessed 8 weeks later (T1). Predictors of virological status were determined by logistic regression analysis. Drug resistance-associated mutations (RAMs) were detected by Sanger sequencing. Findings: At T0, participants had received treatment for a median of 8·9 years; 297/333 (89·2%) were on NNRTI-based ART. The viral load was ≥40 copies/mL in 164/333 (49·2%) patients and ≥1000 copies/mL in 71/333 (21·3%). In the latter group, 50/65 (76·9%) and 55/65 (84·6%) harboured NRTI and NNRTI RAMs, respectively, and 27/65 (41·5%) had ≥1 tenofovir RAM. Among 150/164 (91·5%) viraemic patients that reattended at T1, 32/150 (21·3%) showed resuppression <40 copies/mL, comprising 1/65 (1·5%) subjects with T0 viral load ≥1000 copies/mL and 31/85 (36·5%) subjects with lower levels. A T0 viral load ≥1000 copies/mL and detection of RAMs predicted ongoing T1 viraemia independently of self-reported adherence levels. Among participants with T0 viral load ≥1000 copies/mL, 23/65 (35·4%) showed resuppression <1000 copies/mL; the response was more likely among those with higher adherence levels and no RAMs. Interpretation: Same-day point-of-care viral load testing was feasible and revealed poor virological control and suboptimal resuppression rates despite adherence counselling. Controlled studies should determine optimal triaging modalities for same-day versus deferred viral load testing.

Item Type: Article
Uncontrolled Keywords: HIV, Virological monitoring, Point-of-care, Adherence, Resuppression, Drug resistance
Depositing User: Symplectic Admin
Date Deposited: 17 Jan 2020 13:13
Last Modified: 23 Apr 2021 07:24
DOI: 10.1016/j.eclinm.2019.12.001
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3071005