The Experts below are selected from a list of 8442 Experts worldwide ranked by ideXlab platform
Wendy Stevens - One of the best experts on this subject based on the ideXlab platform.
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The Development of a Standardized Quality Assessment Material to Support Xpert® HIV-1 Viral Load Testing for ART Monitoring in South Africa.
Diagnostics (Basel Switzerland), 2021Co-Authors: Lara Noble, Lesley Scott, Asiashu Bongwe, Pedro Da Silva, Wendy StevensAbstract:The tiered laboratory framework for human immunodeficiency virus (HIV) Viral Load monitoring accommodates a range of HIV Viral Load Testing platforms, with quality assessment critical to ensure quality patient Testing. HIV plasma Viral Load Testing is challenged by the instability of Viral RNA. An approach using an RNA stabilizing buffer is described for the Xpert® HIV-1 Viral Load (Cepheid) assay and was tested in remote laboratories in South Africa. Plasma panels with known HIV Viral titres were prepared in PrimeStore molecular transport medium for per-module verification and per-instrument external quality assessment. The panels were transported at ambient temperatures to 13 Testing laboratories during 2017 and 2018, tested according to standard procedures and upLoaded to a web portal for analysis. A total of 275 quality assessment specimens (57 verification panels and two EQA cycles) were tested. All participating laboratories met study verification criteria (n = 171 specimens) with an overall concordance correlation coefficient (ρc) of 0.997 (95% confidence interval (CI): 0.996 to 0.998) and a mean bias of −0.019 log copies per milliliter (cp/mL) (95% CI: −0.044 to 0.063). The overall EQA ρc (n = 104 specimens) was 0.999 (95% CI: 0.998 to 0.999), with a mean bias of 0.03 log cp/mL (95% CI: 0.02 to 0.05). These panels are suitable for use in quality monitoring of Xpert® HIV-1 VL and are applicable to laboratories in remote settings.
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The Development of a Standardized Quality Assessment Material to Support Xpert HIV-1 Viral Load Testing for ART Monitoring in South Africa
2020Co-Authors: Lara Noble, Lesley Scott, Asiashu Bongwe, Pedro Da Silva, Wendy StevensAbstract:The tiered laboratory framework for HIV Viral Load monitoring accommodates a range of HIV Viral Load Testing platforms, with quality assessment critical to ensure quality patient Testing. HIV plasma Viral Load Testing is challenged by the instability of Viral RNA. An approach using an RNA stabilizing buffer is described for the Xpert HIV-1 Viral Load (Cepheid) assay and was tested in remote laboratories in South Africa. EDTA-plasma panels with known HIV Viral titres was prepared in PrimeStore molecular transport medium for per-module verification and per-instrument external quality assessment. The panels were transported at ambient temperature to 13 Testing laboratories during 2017-2018, tested according to standard procedures and upLoaded to a web portal for analysis A total of 275 quality assessment specimens (57 verification panels and two EQA cycles) were tested. All participants passed verification (n=171 specimens) with an overall concordance correlation (ρc) of 0.997 (95%confidence interval [CI]:0.996,0.998) and a mean log bias of -0.019log cp/mL (95%CI:-0.044,0.063). The overall EQA ρc (n=104 specimens) was 0.999 (95%CI:0.998,0.999), with a mean log bias of 0.03 log cp/mL 95%(CI:0.02,0.05). The panels are suitable for use in quality monitoring of Xpert HIV-1 VL and are applicable to laboratories in remote settings.
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Monitoring Viral Load for the last mile: what will it cost?
Journal of the International AIDS Society, 2019Co-Authors: Brooke E Nichols, Wendy Stevens, Sarah J Girdwood, Thomas Crompton, Lynsey Stewart-isherwood, Leigh Berrie, Dorman Chimhamhiwa, Crispin Moyo, John Kuehnle, Sydney RosenAbstract:INTRODUCTION Routine Viral Load Testing is the WHO-recommended method for monitoring HIV-infected patients on ART, and many countries are rapidly scaling up Testing capacity at centralized laboratories. Providing Testing access to the most remote populations and facilities (the "last mile") is especially challenging. Using a geospatial optimization model, we estimated the incremental costs of accessing the most remote 20% of patients in Zambia by expanding the transportation network required to bring blood samples from ART clinics to centralized laboratories and return results to clinics. METHODS The model first optimized a sample transportation network (STN) that can transport 80% of anticipated sample volumes to centralized Viral Load Testing laboratories on a daily or weekly basis, in line with Zambia's 2020 targets. Data incorporated into the model included the location and infrastructure of all health facilities providing ART, location of laboratories, measured distances and drive times between the two, expected future Viral Load demand by health facility, and local cost estimates. We then continued to expand the modelled STN in 5% increments until 100% of all samples could be collected. RESULTS AND DISCUSSION The cost per Viral Load test when reaching 80% patient volumes using centralized Viral Load Testing was a median of $18.99. With an expanded STN, the incremental cost per test rose to $20.29 for 80% to 85% and $20.52 for 85% to 90%. Above 90% coverage, the incremental cost per test increased substantially to $31.57 for 90% to 95% and $51.95 for 95% to 100%. The high numbers of kilometres driven per sample transported and large number of vehicles needed increase costs dramatically for reaching the clinics that serve the last 5% of patients. CONCLUSIONS Providing sample transport services to the most remote clinics in low- and middle-income countries is likely to be cost-prohibitive. Other strategies are needed to reduce the cost and increase the feasibility of making Viral Load monitoring available to the last 10% of patients. The cost of alternative methods, such as optimal point-of-care Viral Load equipment placement and usage, dried blood/plasma spot specimen utilization, or use of drones in geographically remote facilities, should be evaluated.
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Early antiretroViral therapy initiation: access and equity of Viral Load Testing for HIV treatment monitoring
The Lancet Infectious Diseases, 2017Co-Authors: Trevor Peter, Dennis Ellenberger, Andrea A. Kim, Debrah I. Boeras, Tsehaynesh Messele, Teri Roberts, Wendy Stevens, Ilesh V. Jani, Alash’le Abimiku, Nathan FordAbstract:Summary Scaling up access to HIV Viral Load Testing for individuals undergoing antiretroViral therapy in low-resource settings is a global health priority, as emphasised by research showing the benefits of suppressed Viral Load for the individual and the whole population. Historically, large-scale diagnostic test implementation has been slow and incomplete because of service delivery and other challenges. Building on lessons from the past, in this Personal View we propose a new framework to accelerate Viral Load scale-up and ensure equitable access to this essential test. The framework includes the following steps: (1) ensuring adequate financial investment in scaling up this test; (2) achieving pricing agreements and consolidating procurement to lower prices of the test; (3) strengthening functional tiered laboratory networks and systems to expand access to reliable, high-quality Testing across countries; (4) strengthening national leadership, with prioritisation of laboratory services; and (5) demand creation and uptake of test results by clinicians, nurses, and patients, which will be vital in ensuring Viral Load tests are appropriately used to improve the quality of care. The use of dried blood spots to stabilise and ship samples from clinics to laboratories, and the use of point-of-care diagnostic tests, will also be important for ensuring access, especially in settings with reduced laboratory capacity. For countries that have just started to scale up Viral Load Testing, lessons can be learnt from countries such as Botswana, Brazil, South Africa, and Thailand, which have already established Viral Load programmes. This framework might be useful for guiding the implementation of Viral Load with the aim of achieving the new global HIV 90-90-90 goals by 2020.
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Use of a Prequalification Panel for Rapid Scale-Up of High-Throughput HIV Viral Load Testing
Journal of Clinical Microbiology, 2012Co-Authors: Lesley Scott, Sergio Carmona, Natasha Gous, Pamela Horsfield, Melanie Mackay, Wendy StevensAbstract:Increased access to antiretroViral drugs expands needs for Viral Load (VL) Testing. South Africa's National Health Laboratory Service responded to demands by implementing two Testing platforms in 17 laboratories within 8 months. An industry partner's collaboration, training programs, and method verification with a VL prequalification panel ensured Testing quality and rapid implementation.
Jienchi Dorward - One of the best experts on this subject based on the ideXlab platform.
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protocol for a randomised feasibility study of point of care hiv Viral Load Testing to enhance re suppression in south africa the power study
BMJ Open, 2021Co-Authors: Jienchi Dorward, Natasha Samsunder, Hope Ngobese, Pravikrishnen Moodley, Yukteshwar Sookrajh, Richard Lessells, Fathima Sayed, Elliot Bulo, Lara Lewis, Sarah TonkincrineAbstract:INTRODUCTION Access to HIV Viral Load Testing remains difficult for many people on antiretroViral therapy (ART) in low-income and middle-income countries. Weak laboratory and clinic systems often delay the detection and management of viraemia, which can lead to morbidity, drug resistance and HIV transmission. Point-of-care Testing could overcome these challenges. We aim to assess whether it is feasible to conduct a randomised trial of point-of-care Viral Load Testing to manage viraemia. METHODS AND ANALYSIS We will conduct an open-label, single-site, individually randomised, feasibility study of Point-Of-care HIV Viral Load Testing to Enhance Re-suppression, in Durban, South Africa. We will enrol approximately 100 people living with HIV who are aged ≥18 years, receiving first-line ART but with recent viraemia ≥1000 copies/mL, and randomise them 1:1 to receive point-of-care Viral Load or standard laboratory Viral Load monitoring, after 12 weeks. All participants will continue to receive care from public sector healthcare workers following South African HIV management guidelines. Participants with persistent viraemia ≥1000 copies/mL will be considered for switching to second-line ART. We will compare the proportion in each study arm who achieve the primary outcome of Viral suppression <50 copies/mL at 24 weeks after enrolment. Additional outcomes include proportions retained in the study, proportions with HIV drug resistance, time to Viral Load results and time to switching to second-line ART. We will assess implementation of point-of-care Viral Load Testing using process evaluation data, and through interviews and focus groups with healthcare workers. ETHICS AND DISSEMINATION University of Oxford Tropical Research Ethics Committee and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal have approved the study. We will present results to stakeholders, and through conferences and open-access, peer-reviewed journals. TRIAL REGISTRATION NUMBER PACTR202001785886049.
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Protocol for a randomised feasibility study of Point-Of-care HIV Viral Load Testing to Enhance Re-suppression in South Africa: the POwER study.
BMJ open, 2021Co-Authors: Jienchi Dorward, Natasha Samsunder, Hope Ngobese, Yukteshwar Sookrajh, Richard Lessells, Fathima Sayed, Elliot Bulo, Lara Lewis, P Moodley, Sarah Tonkin-crineAbstract:Access to HIV Viral Load Testing remains difficult for many people on antiretroViral therapy (ART) in low-income and middle-income countries. Weak laboratory and clinic systems often delay the detection and management of viraemia, which can lead to morbidity, drug resistance and HIV transmission. Point-of-care Testing could overcome these challenges. We aim to assess whether it is feasible to conduct a randomised trial of point-of-care Viral Load Testing to manage viraemia. We will conduct an open-label, single-site, individually randomised, feasibility study of Point-Of-care HIV Viral Load Testing to Enhance Re-suppression, in Durban, South Africa. We will enrol approximately 100 people living with HIV who are aged ≥18 years, receiving first-line ART but with recent viraemia ≥1000 copies/mL, and randomise them 1:1 to receive point-of-care Viral Load or standard laboratory Viral Load monitoring, after 12 weeks. All participants will continue to receive care from public sector healthcare workers following South African HIV management guidelines. Participants with persistent viraemia ≥1000 copies/mL will be considered for switching to second-line ART. We will compare the proportion in each study arm who achieve the primary outcome of Viral suppression <50 copies/mL at 24 weeks after enrolment. Additional outcomes include proportions retained in the study, proportions with HIV drug resistance, time to Viral Load results and time to switching to second-line ART. We will assess implementation of point-of-care Viral Load Testing using process evaluation data, and through interviews and focus groups with healthcare workers. University of Oxford Tropical Research Ethics Committee and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal have approved the study. We will present results to stakeholders, and through conferences and open-access, peer-reviewed journals. PACTR202001785886049. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
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Point-of-care HIV Viral Load Testing combined with task shifting to improve treatment outcomes (STREAM): findings from an open-label, non-inferiority, randomised controlled trial
The Lancet HIV, 2020Co-Authors: Paul K. Drain, Jienchi Dorward, Lauren R Violette, Justice Quame-amaglo, Katherine K. Thomas, Natasha Samsunder, Hope Ngobese, Koleka Mlisana, Pravikrishnen Moodley, Deborah DonnellAbstract:Summary Background Monitoring HIV treatment with laboratory Testing introduces delays for providing appropriate care in resource-limited settings. The aim of our study was to determine whether point-of-care HIV Viral Load Testing with task shifting changed treatment and care outcomes for adults on antiretroViral therapy (ART) when compared with standard laboratory Viral Load Testing. Methods We did an open-label, non-inferiority, randomised controlled trial in a public clinic in Durban, South Africa. We enrolled HIV-positive adults (aged ≥18 years) who presented for their first routine HIV Viral Load test 6 months after ART initiation. Individuals were randomly assigned by a random number allocation sequence to receive either point-of-care Viral Load Testing at enrolment and after 6 months with task shifting to enrolled nurses (intervention group), or laboratory Viral Load Testing (standard-of-care group). The primary outcome was combined Viral suppression ( ClinicalTrials.gov , NCT03066128 . Findings Between Feb 24, 2017, and Aug 23, 2017, we screened 657 participants, and 390 were enrolled and randomly assigned to either the intervention group (n=195) or standard-of-care group (n=195). 175 (90%) individuals in the intervention group and 148 (76%) individuals in the standard-of-care group had the primary outcome of retention with Viral suppression, a difference of 13·9% (95% CI 6·4–21·2; p Interpretation Point-of-care Viral Load Testing combined with task shifting significantly improved Viral suppression and retention in HIV care. Point-of-care Testing can simplify treatment and improve outcomes for HIV-positive adults receiving ART in resource-limited settings. Funding National Institute of Allergy and Infectious Diseases.
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Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response.
Clinical Microbiology Reviews, 2019Co-Authors: Paul K. Drain, Jienchi Dorward, Andrew T. Bender, Lorraine Lillis, Francesco Marinucci, Jilian Sacks, Anna Bershteyn, David S. Boyle, Jonathan D. Posner, Nigel GarrettAbstract:The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV Viral Load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV Viral Load in people living with HIV is therefore central to maintaining effective individual antiretroViral therapy as well as monitoring progress toward achieving population targets for Viral suppression. The capacity for laboratory-based HIV Viral Load Testing has increased rapidly in low- and middle-income countries, but implementation of universal Viral Load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV Viral Load Testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient Testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized Viral Load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV Viral Load Testing.
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point of care hiv Viral Load Testing an essential tool for a sustainable global hiv aids response
Clinical Microbiology Reviews, 2019Co-Authors: Paul K. Drain, Jienchi Dorward, Andrew T. Bender, Lorraine Lillis, Francesco Marinucci, Jilian Sacks, Anna Bershteyn, David S. Boyle, Jonathan D. PosnerAbstract:The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV Viral Load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV Viral Load in people living with HIV is therefore central to maintaining effective individual antiretroViral therapy as well as monitoring progress toward achieving population targets for Viral suppression. The capacity for laboratory-based HIV Viral Load Testing has increased rapidly in low- and middle-income countries, but implementation of universal Viral Load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV Viral Load Testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient Testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized Viral Load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV Viral Load Testing.
Lesley Scott - One of the best experts on this subject based on the ideXlab platform.
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The Development of a Standardized Quality Assessment Material to Support Xpert® HIV-1 Viral Load Testing for ART Monitoring in South Africa.
Diagnostics (Basel Switzerland), 2021Co-Authors: Lara Noble, Lesley Scott, Asiashu Bongwe, Pedro Da Silva, Wendy StevensAbstract:The tiered laboratory framework for human immunodeficiency virus (HIV) Viral Load monitoring accommodates a range of HIV Viral Load Testing platforms, with quality assessment critical to ensure quality patient Testing. HIV plasma Viral Load Testing is challenged by the instability of Viral RNA. An approach using an RNA stabilizing buffer is described for the Xpert® HIV-1 Viral Load (Cepheid) assay and was tested in remote laboratories in South Africa. Plasma panels with known HIV Viral titres were prepared in PrimeStore molecular transport medium for per-module verification and per-instrument external quality assessment. The panels were transported at ambient temperatures to 13 Testing laboratories during 2017 and 2018, tested according to standard procedures and upLoaded to a web portal for analysis. A total of 275 quality assessment specimens (57 verification panels and two EQA cycles) were tested. All participating laboratories met study verification criteria (n = 171 specimens) with an overall concordance correlation coefficient (ρc) of 0.997 (95% confidence interval (CI): 0.996 to 0.998) and a mean bias of −0.019 log copies per milliliter (cp/mL) (95% CI: −0.044 to 0.063). The overall EQA ρc (n = 104 specimens) was 0.999 (95% CI: 0.998 to 0.999), with a mean bias of 0.03 log cp/mL (95% CI: 0.02 to 0.05). These panels are suitable for use in quality monitoring of Xpert® HIV-1 VL and are applicable to laboratories in remote settings.
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The Development of a Standardized Quality Assessment Material to Support Xpert HIV-1 Viral Load Testing for ART Monitoring in South Africa
2020Co-Authors: Lara Noble, Lesley Scott, Asiashu Bongwe, Pedro Da Silva, Wendy StevensAbstract:The tiered laboratory framework for HIV Viral Load monitoring accommodates a range of HIV Viral Load Testing platforms, with quality assessment critical to ensure quality patient Testing. HIV plasma Viral Load Testing is challenged by the instability of Viral RNA. An approach using an RNA stabilizing buffer is described for the Xpert HIV-1 Viral Load (Cepheid) assay and was tested in remote laboratories in South Africa. EDTA-plasma panels with known HIV Viral titres was prepared in PrimeStore molecular transport medium for per-module verification and per-instrument external quality assessment. The panels were transported at ambient temperature to 13 Testing laboratories during 2017-2018, tested according to standard procedures and upLoaded to a web portal for analysis A total of 275 quality assessment specimens (57 verification panels and two EQA cycles) were tested. All participants passed verification (n=171 specimens) with an overall concordance correlation (ρc) of 0.997 (95%confidence interval [CI]:0.996,0.998) and a mean log bias of -0.019log cp/mL (95%CI:-0.044,0.063). The overall EQA ρc (n=104 specimens) was 0.999 (95%CI:0.998,0.999), with a mean log bias of 0.03 log cp/mL 95%(CI:0.02,0.05). The panels are suitable for use in quality monitoring of Xpert HIV-1 VL and are applicable to laboratories in remote settings.
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evaluation of the use of plasma preparation tubes for hiv Viral Load Testing on the cobas ampliprep cobas taqman hiv 1 version 2 0
Journal of Virological Methods, 2013Co-Authors: Dominique Goedhals, Lesley Scott, Serena A. Moretti, Mark A. Cooper, Willem J.l. Opperman, Inéz RossouwAbstract:Abstract HIV Viral Load monitoring forms an essential part of the management of patients receiving antiretroViral therapy, but transport of samples without loss of RNA integrity may be problematic in resource limited settings. The use of plasma preparation tubes (PPT) which can be centrifuged to separate cellular components before transport may provide a simple and cost-effective alternative to standard EDTA samples. We investigated whether PPT generated reliable results using the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 test version 2.0 (CAP/CTM HIV-1 v2.0). The mean difference between EDTA and PPT prepared samples (n = 261) was acceptable (log 0.04 copies/ml, percentage similarity CV 3.53%). PPT can be used for Viral Load Testing on the CAP/CTM HIV-1 v2.0.
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Evaluation of the use of plasma preparation tubes for HIV Viral Load Testing on the COBAS AmpliPrep/COBAS TaqMan HIV-1 version 2.0
Journal of Virological Methods, 2013Co-Authors: Dominique Goedhals, Lesley Scott, Serena A. Moretti, Mark A. Cooper, Willem J.l. Opperman, Inéz RossouwAbstract:Abstract HIV Viral Load monitoring forms an essential part of the management of patients receiving antiretroViral therapy, but transport of samples without loss of RNA integrity may be problematic in resource limited settings. The use of plasma preparation tubes (PPT) which can be centrifuged to separate cellular components before transport may provide a simple and cost-effective alternative to standard EDTA samples. We investigated whether PPT generated reliable results using the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 test version 2.0 (CAP/CTM HIV-1 v2.0). The mean difference between EDTA and PPT prepared samples (n = 261) was acceptable (log 0.04 copies/ml, percentage similarity CV 3.53%). PPT can be used for Viral Load Testing on the CAP/CTM HIV-1 v2.0.
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Use of a Prequalification Panel for Rapid Scale-Up of High-Throughput HIV Viral Load Testing
Journal of Clinical Microbiology, 2012Co-Authors: Lesley Scott, Sergio Carmona, Natasha Gous, Pamela Horsfield, Melanie Mackay, Wendy StevensAbstract:Increased access to antiretroViral drugs expands needs for Viral Load (VL) Testing. South Africa's National Health Laboratory Service responded to demands by implementing two Testing platforms in 17 laboratories within 8 months. An industry partner's collaboration, training programs, and method verification with a VL prequalification panel ensured Testing quality and rapid implementation.
Paul K. Drain - One of the best experts on this subject based on the ideXlab platform.
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Point-of-care HIV Viral Load Testing combined with task shifting to improve treatment outcomes (STREAM): findings from an open-label, non-inferiority, randomised controlled trial
The Lancet HIV, 2020Co-Authors: Paul K. Drain, Jienchi Dorward, Lauren R Violette, Justice Quame-amaglo, Katherine K. Thomas, Natasha Samsunder, Hope Ngobese, Koleka Mlisana, Pravikrishnen Moodley, Deborah DonnellAbstract:Summary Background Monitoring HIV treatment with laboratory Testing introduces delays for providing appropriate care in resource-limited settings. The aim of our study was to determine whether point-of-care HIV Viral Load Testing with task shifting changed treatment and care outcomes for adults on antiretroViral therapy (ART) when compared with standard laboratory Viral Load Testing. Methods We did an open-label, non-inferiority, randomised controlled trial in a public clinic in Durban, South Africa. We enrolled HIV-positive adults (aged ≥18 years) who presented for their first routine HIV Viral Load test 6 months after ART initiation. Individuals were randomly assigned by a random number allocation sequence to receive either point-of-care Viral Load Testing at enrolment and after 6 months with task shifting to enrolled nurses (intervention group), or laboratory Viral Load Testing (standard-of-care group). The primary outcome was combined Viral suppression ( ClinicalTrials.gov , NCT03066128 . Findings Between Feb 24, 2017, and Aug 23, 2017, we screened 657 participants, and 390 were enrolled and randomly assigned to either the intervention group (n=195) or standard-of-care group (n=195). 175 (90%) individuals in the intervention group and 148 (76%) individuals in the standard-of-care group had the primary outcome of retention with Viral suppression, a difference of 13·9% (95% CI 6·4–21·2; p Interpretation Point-of-care Viral Load Testing combined with task shifting significantly improved Viral suppression and retention in HIV care. Point-of-care Testing can simplify treatment and improve outcomes for HIV-positive adults receiving ART in resource-limited settings. Funding National Institute of Allergy and Infectious Diseases.
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Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response.
Clinical Microbiology Reviews, 2019Co-Authors: Paul K. Drain, Jienchi Dorward, Andrew T. Bender, Lorraine Lillis, Francesco Marinucci, Jilian Sacks, Anna Bershteyn, David S. Boyle, Jonathan D. Posner, Nigel GarrettAbstract:The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV Viral Load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV Viral Load in people living with HIV is therefore central to maintaining effective individual antiretroViral therapy as well as monitoring progress toward achieving population targets for Viral suppression. The capacity for laboratory-based HIV Viral Load Testing has increased rapidly in low- and middle-income countries, but implementation of universal Viral Load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV Viral Load Testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient Testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized Viral Load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV Viral Load Testing.
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point of care hiv Viral Load Testing an essential tool for a sustainable global hiv aids response
Clinical Microbiology Reviews, 2019Co-Authors: Paul K. Drain, Jienchi Dorward, Andrew T. Bender, Lorraine Lillis, Francesco Marinucci, Jilian Sacks, Anna Bershteyn, David S. Boyle, Jonathan D. PosnerAbstract:The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV Viral Load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV Viral Load in people living with HIV is therefore central to maintaining effective individual antiretroViral therapy as well as monitoring progress toward achieving population targets for Viral suppression. The capacity for laboratory-based HIV Viral Load Testing has increased rapidly in low- and middle-income countries, but implementation of universal Viral Load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV Viral Load Testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient Testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized Viral Load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV Viral Load Testing.
Eric Nerrienet - One of the best experts on this subject based on the ideXlab platform.
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Current challenges to Viral Load Testing in the context of emerging genetic diversity of HIV-1.
Expert Opinion on Medical Diagnostics, 2011Co-Authors: François Rouet, Florian Liegeois, Augustin Mouinga-ondémé, Dramane Kania, Johannes Viljoen, Sammy Wambua, Nicole Ngo-giang-huong, Hervé Menan, Martine Peeters, Eric NerrienetAbstract:Introduction: One of the major characteristics of HIV-1 is its extreme genetic diversity. A key factor in assessing the sensitivity of a molecular-based assay measuring HIV-1 RNA Viral Load (VL) in plasma is its ability to detect/quantify all (or most of) relevant HIV-1 genetic subtype/recombinant forms accurately. Areas covered: This review provides an overview of the current commercially available quantitative real-time assays (the Abbott RealTime HIV-1, Roche TaqMan HIV-1 versions 1.0 and 2.0, BioMerieux Nuclisens EasyQ HIV-1, Siemens VERSANT HIV-1 RNA 1.0 kinetic PCR, and Biocentric Generic HIV Viral Load assays). For each assay, studies from 2005 to 2010 assessing the impact of HIV-1 genetic diversity on the reliability of HIV-1 RNA quantification are described. Expert opinion: In light of HIV-1 genetic diversity, a general recommendation to favor one test over the other cannot categorically be made. Larger field evaluations of HIV-1 RNA assays should be conducted in areas where HIV-1 genetic diversi...
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Current challenges to Viral Load Testing in the context of emerging genetic diversity of HIV-1.
Expert opinion on medical diagnostics, 2011Co-Authors: François Rouet, Florian Liegeois, Augustin Mouinga-ondémé, Dramane Kania, Johannes Viljoen, Sammy Wambua, Nicole Ngo-giang-huong, Hervé Menan, Martine Peeters, Eric NerrienetAbstract:One of the major characteristics of HIV-1 is its extreme genetic diversity. A key factor in assessing the sensitivity of a molecular-based assay measuring HIV-1 RNA Viral Load (VL) in plasma is its ability to detect/quantify all (or most of) relevant HIV-1 genetic subtype/recombinant forms accurately. This review provides an overview of the current commercially available quantitative real-time assays (the Abbott RealTime HIV-1, Roche TaqMan HIV-1 versions 1.0 and 2.0, BioMérieux Nuclisens EasyQ HIV-1, Siemens VERSANT HIV-1 RNA 1.0 kinetic PCR, and Biocentric Generic HIV Viral Load assays). For each assay, studies from 2005 to 2010 assessing the impact of HIV-1 genetic diversity on the reliability of HIV-1 RNA quantification are described. In light of HIV-1 genetic diversity, a general recommendation to favor one test over the other cannot categorically be made. Larger field evaluations of HIV-1 RNA assays should be conducted in areas where HIV-1 genetic diversity is the highest. The large-scale implementation of HIV-1 VL Testing is urgently required in the developing world to change HIV infection from a likely death sentence into a manageable chronic infection, as done in Northern countries.