Letters to the Editor How innovation can help end the Aids epidemic by 2030

test results back from laboratories that are often situated great distances from clinics.

One way round the problem is to enable viral load testing to take place at primary health care level – what’s known as point-ofcare viral load testing. This would be a game changer.

Results would be known immediately and health workers could intervene swiftly by evaluating antiretroviral treatments in real time. This would, in turn, improve treatment outcomes.

But achieving this requires innovation. A new approach is being piloted. The idea is to test if point-of-care viral load monitoring is in reach.

Monitoring the viral loads of people on antiretroviral therapy is an essential part of HIV management. Viral load testing helps doctors determine if a person is taking their medication as prescribed. It also helps to determine if patients are on the correct combination of antiretroviral drugs.

It’s a key part of the arsenal against HIV because research shows that people who are virally suppressed are less likely to pass on the virus to someone else. That makes it a key factor in breaking the cycle of transmission.

The most efficient way of doing this is through point-of-care testing sites. These are based within the community so that patients don’t have to travel long distances to get tests done as well as to receive treatment. This new model is being piloted with the aim of providing convenient access to care for patients.

Currently nearly all viral load testing is conducted in centralised and designated laboratories. This means that there can be lags in getting results back to the field. Patients can wait for weeks.

Laboratory based viral load testing is also expensive. Point-of-care testing is also cheaper than lab-based viral loads: health care workers could do the test rather than highly paid technicians.

Small steps have been made in the direction of enabling viral load monitoring to be done at point of care.

But additional equipment is also needed. Pilots evaluating point-of-care viral load testing are ongoing. A pilot is being run using a portable testing machine — the m-PIMA HIV1/2 — that fits on a desk top and can provide an accurate reading of viral load in under 70 minutes.

The machine is being tested to establish whether it meets WHO standards. Once it is given the stamp of approval by the WHO, ministries of health can start the implementation at all sites.

All countries still struggling to bring the HIV pandemic under control are focused on achieving the 90-90-90 goals.

South Africa, which still has the biggest HIV epidemic in the world, with 7.9 million people living with HIV, is no exception, and is making significant progress.

It is edging closer to the target of having 90 percent of people with HIV knowing their status. And it’s made significant progress on the second target that 90 percent of people with HIV should be on treatment.

But it has some way to go on the third. While the country is on track to meet the goal that 90 percent of people on treatment be virally suppressed, it’s advances on this front haven’t been uniform. Some regions of the country still lag behind others. Being able to roll out point of care testing would go a long way in helping close these gaps. Glenda Ray