title: Viral load monitoring as a tool to reinforce adherence: a systematic review.
abstract: OBJECTIVE
  Viral load monitoring has been proposed as a tool to reinforce adherence, but outcomes have never been systematically assessed.
  
  
  METHODS
  A meta-analysis was conducted to systematically analyze the research on viral load monitoring as a tool to reinforce adherence. Viremic resuppression is defined here as a decrease in viral load beneath a particular threshold following viral load levels that have been elevated despite antiretroviral treatment.
  
  
  METHODS
  Six databases were searched for studies published up to November 2012, which reported the use of viral load monitoring as a tool to identify patients in need of adherence support. Three conference abstract sites were reviewed for studies reported in the last 2 years. Randomized and quasi-randomized trials and observational studies, were eligible. No language or geographical restrictions were applied.
  
  
  RESULTS
  Six retrospective and 2 prospective observational studies reported data from 8 countries: South Africa, the United States, Thailand, Mali, Burkina Faso, Swaziland, India, and France. Five studies reported on viremic resuppression, with a pooled estimate of 70.5% (95% confidence interval: 56.6% to 84.4%) resuppressed. The remaining 3 studies all reported declines in mean viral load. Delayed onset of routine viral load monitoring was associated with the emergence of drug resistance.
  
  
  CONCLUSIONS
  The clear trend of resuppression, following viral load testing and adherence support, demonstrates the utility of viral load as a tool to identify patients in need of enhanced adherence support.
authors.affiliation: Access Campaign, Médecins Sans Frontières, Geneva, Switzerland. Kimberly.bonner@geneva.msf.org
authors.forename: Kimberly
authors.initials: K
authors.lastname: Bonner
authors.forename: Alyssa
authors.initials: A
authors.lastname: Mezochow
authors.forename: Teri
authors.initials: T
authors.lastname: Roberts
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cohn
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D024882:Drug Resistance, Viral / Q000276:immunology; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D008297:Male; D011594:Psychometrics; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D019562:Viral Load / Q000187:drug effects / Q000706:statistics & numerical data; D014944:World Health Organization; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents