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

Chronicle (Zimbabwe) - - Front Page -

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

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