Point-of-care HIV viral load testing combined with task shifting can improve viral suppression and retention in care by up to 14% and enable rapid care decisions, suggest results of a clinical trial led by the University of Washington and the Centre for the AIDS Programme of Research in South Africa (CAPRISA).
The trial took place at a large public clinic in Durban, South Africa, and involved 390 HIV-positive adults who were receiving their first routine viral load test after beginning antiretroviral therapy (ART) six months prior. Results were published Feb. 10 in The Lancet HIV.
“This is the first randomized trial to demonstrate an impact for improving viral suppression of HIV,” said lead author Paul Drain, an assistant professor in the Department of Global Health at the UW, which bridges the UW Schools of Public Health and Medicine. “These results will help guide the response to ending the HIV epidemic.” Drain is also an assistant professor of medicine and an adjunct assistant professor of epidemiology. Nigel Garrett, CAPRISA’s head of pathogenesis and vaccine research, is senior author of the study.
Roughly half of all people living with HIV globally have viral suppression, and large regional disparities in ART coverage and HIV treatment outcomes still exist. Monitoring HIV treatment with centralized laboratory testing can cause delays in providing appropriate care, especially in resource-limited settings. On the other hand, point-of-care testing can be performed at the time and place of patient care and, therefore, results are typically available more quickly and can be acted upon without delay.
This trial is the first of its kind to evaluate the effect of point-of-care HIV viral load monitoring for people living with HIV and receiving ART, according to study authors. The investigators paired a relatively new point-of-care test by Cepheid with the practice of task shifting, whereby duties are reassigned, where appropriate, from professional nurses to health-care workers with less training, such as enrolled nurses. Previous research has shown that task shifting has the potential to improve health care delivery at a relatively low cost.
In collaboration with the eThekwini Municipality and the National Health Laboratory Services, the CAPRISA and UW team conducted the Simplifying HIV TREAtment and Monitoring, or STREAM, trial at the Prince Cyril Zulu Clinic in central Durban. Between February and August 2017, the team randomly assigned participants to receive either point-of-care viral load testing with task shifting (intervention group) or laboratory viral load testing (standard-of-care group).
Results not only show that the combined approach significantly improved viral suppression and retention in care, driven in large part by point-of-care testing, but that the tests substantially accelerated the switch to second-line ART for those with treatment failure as well as referral of stable patients to a community-based ART delivery program. During the study, 99% of intervention participants received their viral load results on the same day, compared to 81% of standard-of-care participants.
The study was funded by the National Institute of Health (NIH), US. The team has since received further NIH funding to assess point-of-care viral load testing in a larger population in combination with other point-of-care tests to improve HIV treatment outcomes further. Co-authors are Jienchi Dorward, Lauran Violette, Justice Quame-Amaglo, Katherine Thomas, Natasha Samsunder, Hope Ngobese, Koleka Milsana, Pravikrishnen Moodley, Deborah Donnell, Ruanne Barnabas, Kogieleum Naidoo, Salim Abdool Karim and Connie Celum.