Simplification, cost-reduction strategies and examples from the
field Teri Roberts Diagnostics Advisor Medecins Sans Frontieres,
Access Campaign 7th International AIDS Conference 2 July 2013
Slide 2
Virological monitoring detects treatment failure earlier than
clinico-immunological monitoring
Slide 3
How viral load testing fits into the package of care to ensure
people stay undetectable Early treatment Routine viral load
Adherence support Community- based & self- managed therapy Drop
routine CD4 monitoring for virally suppressed ART treated PLWHA and
rather use routine VL monitoring to trigger the need for CD4
testing (is CD4 over 200 cells/ul?)
Slide 4
Viremic patients can re-suppress following an adherence
intervention
Slide 5
The importance of preserving first line, affordable, robust,
one-pill-a-day regimens
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Slide 7
Implementation is done in support of, and in collaboration
with, the Ministries of Health and reference laboratories SAMBA
CAVIDI BIOMERIEUX BIOCENTRIC
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Slide 9
G. Patten et al. Poster TUPDD0106 (Oral abstract session: The
point of point of care (Tuesday)) Youth and adolescents have been
identified as a particularly vulnerable group, at greater risk of
loss from both pre-ART and ART care. MSF supported clinic in
Khayelitsha, Cape Town, South Africa: implemented POC CD4-testing
at a clinic dedicated to youth aged 12 to 25 years. POC CD4 testing
significantly improved assessment for ART eligibility, ensuring
that most youth were made aware of their treatment needs on the day
of HIV diagnosis. Does point-of-care (POC) CD4 testing reduce
losses from care between HIV diagnosis, assessment for ART
eligibility and ART initiation among HIV-positive youth in
Khayelitsha, South Africa?
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Group A (Before)Group B (After) HIV Testing Blood sample drawn
for CD4 counting WHO Staging* ART preparation counselling sessions
ART Initiation CD4 Result ART eligibility assessed Visit 1 Visit 2
Visit 3 Visit 4 Visit 5 Visit 6 HIV Testing Blood sample drawn for
CD4 counting WHO Staging ART preparation counselling session ART
Initiation CD4 Result ART eligibility assessed Visit 1 Visit 2
Visit 3 Visit 4 Visit 5 44% 50% 34 days 28 days P=0.6
Slide 11
Slide 12
Point-of-care versus laboratory-based tests for viral load
testing Regional-level laboratory tests will use dried blood spot
samples that can use finger or heel prick blood
Slide 13
Diagnostic accuracy of DBS using the COBAS Ampliprep/COBAS
TaqMan HIV-1 v2.0 (CAP/CTM) NMRL, Harare, Zimbabwe in collaboration
with MSF Sekesai Mtapuri-Zinyowera (WEPE610 - Poster Exhibition on
Wednesday) 118 finger prick DBS, venous blood DBS and plasma
specimens from ART patients attending two rural OI clinics in
Buhera and Tsholotsho districts and one urban OI clinic in Harare
good sensitivity of DBS compared to HIV-1 RNA plasma but very low
specificity, which translated in a higher rate of false positive
results with DBS at lower VLs (
Pooling methods, in combination with the use of fingerprick DBS
as a sample type for VL testing, can importantly reduce costs while
maintaining accuracy Efficiency expressed as cost savings: Example
of Thyolo District Population: 620,000 HIV prevalence: 14,5% # VL
tests needed/year: 23,000 Price per VL test: $24 Total cost/year =
23,000 x $24 = $552,000 Efficiency at 1,000 cps/mL = 28,6% =>
$157,800 saved Efficiency at 5,000 cps/mL = 51,4% => $283,700
saved Sample 1 500 L 100 L Pool 500 L Viral load testing 100 L
Sample 2 500 L Sample 3 500 L Sample 4 500 L Sample 5 500 L What to
do with pooled results? 1. Pooled VL result no further testing 2.
Pooled VL result > threshold => further testing MSF has
previously validated the use of fingerprick DBS on the bioMerieux
NucliSENS EasyQ HIV-1 platform, which is RNA-specific
Slide 15
Reports: www.msfaccess.org/reports 2012 IAS poster TUPDD0102
and Oral abstract session: The point of point of care (Tuesday)
2013