Point-of-care viral load testing improves HIV treatment outcomes and retention in care
The results of the first randomised controlled trial to test the impact of rapid, point-of-care viral load testing was presented as a late breaker presentation at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle.
Results showed a 14% improvement in virological suppression and retention in care as the point-of-care viral load test results were available on the same day – a significant improvement in turnaround times compared to standard laboratory testing. The STREAM study (Simplifying HIV TREAtment and Monitoring), which was led by Dr Nigel Garett, Head of Vaccine and Pathogenesis Research at CAPRISA and Dr Paul Drain of the University of Washington, was an open-label, two arm randomized controlled trial conducted at the CAPRISA eThekwini Research clinic and the adjacent Prince Cyril Zulu clinic in Durban, South Africa.
“Delays with obtaining laboratory test results in resource-limited settings present challenges for monitoring antiretroviral therapy (ART),” said Dr Drain. “We assessed whether point-of-care viral load testing with task-shifting to enrolled nurses changed treatment and care outcomes for HIV positive patients on ART.”
Patients were recruited to the study six months after starting ART. The study investigated if rapid viral load testing is an effective and cost-efficient strategy for management of chronic HIV infection in the majority of patients. In the intervention arm, patients received point-of-care testing with the Xpert HIV-1 viral load assay and same-day counselling. If they were virologically suppressed and clinically stable, their care was transferred from a professional nurse to an enrolled nurse. “The beauty of this study was that the intervention was simple to understand for patients and providers”, Dr Garrett said. “The results showed an improvement in viral load suppression and retention, led to earlier ART switches for patients failing therapy, and allowed rapid referral into differentiated, community-based care pathways.”