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- Title
Timeliness of Point-of-Care Viral Load Results Improves Human Immunodeficiency Virus Monitoring in Nigeria.
- Authors
Chaplin, Beth; Agbaji, Oche; Nieva, Harry Reyes; Olatunde, Bola; Chang, Charlotte; Mitruka, Kiren; Sule, Halima; Dajel, Titus; Zee, Aaron; Ahmed, Mukhtar L; Ahmed, Isah; Okonkwo, Prosper; Rawizza, Holly; Kanki, Phyllis
- Abstract
Background Human immunodeficiency virus (HIV) viral load (VL) monitoring is critical for antiretroviral therapy (ART) management. Point-of-care (POC) VL testing has been reported to be feasible and preferred over standard-of-care (SOC) testing in many low- and middle-income country settings where rapid results could improve patient outcomes. Methods The timeliness of receipt of VL results was evaluated in an open-label, randomized, controlled trial among patients newly initiating ART. Clinical outcomes with POC VL monitoring using Cepheid Xpert vs SOC VL at Jos University Teaching Hospital and Comprehensive Health Centre Zamko in Nigeria were assessed. We determined time between specimen collection and recording of VL in patient charts, receipt of results, and ART switch for those who met virologic failure criteria. Results Between April 2018 and October 2019, we screened 696 ART-naive individuals; 273 were randomized to POC and 268 to SOC HIV-1 VL testing. Participants in the POC arm received VL results significantly faster than those in the SOC arm (0.1 median days, interquartile range [IQR], 0.1–0.2 vs 143.1 days, IQR, 56.0–177.1, respectively; P <.0001). Participants in the POC arm with confirmed virologic failure vs those in the SOC arm were switched more rapidly to a second-line regimen (0 median days, IQR, 0–28 vs 66 days, IQR, 63–123, respectively; P =.03). Conclusions POC VL testing resulted in significant improvement in the timeliness of VL result receipt by patients and use for effective HIV clinical management. In patients experiencing VL failure, POC monitoring enabled prompt switching to second-line ART regimens. Clinical Trials Registration NCT03533868.
- Subjects
NIGERIA; HIV infection epidemiology; HIV infections; PUBLIC health surveillance; RESEARCH; HIV-positive persons; ACADEMIC medical centers; VIRAL load; POINT-of-care testing; ANTIRETROVIRAL agents; BLOOD collection; RANDOMIZED controlled trials; TURNAROUND time; QUALITY assurance; RESEARCH funding; DESCRIPTIVE statistics; DECISION making in clinical medicine; STATISTICAL sampling
- Publication
Clinical Infectious Diseases, 2023, Vol 76, Issue 3, pe671
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciac609