title: Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges.
abstract: Despite immense progress in antiretroviral therapy (ART) scale-up, many people still lack access to basic standards of care, with our ability to meet the Joint United Nations Programme on HIV/AIDS 90-90-90 treatment targets for HIV/AIDS dependent on dramatic improvements in diagnostics. The World Health Organization recommends routine monitoring of ART effectiveness using viral load (VL) testing at 6 months and every 12 months, to monitor treatment adherence and minimize failure, and will publish its VL toolkit later this year. However, the cost and complexity of VL is preventing scale-up beyond developed countries and there is a lack of awareness among clinicians as to the long-term patient benefits and its role in prolonging the longevity of treatment programs. With developments in this diagnostic field rapidly evolving-including the recent improvements for accurately using dried blood spots and the imminent appearance to the market of point-of-care technologies offering decentralized diagnosis-we describe current barriers to VL testing in resource-limited settings. Effective scale-up can be achieved through health system and laboratory system strengthening and test price reductions, as well as tackling multiple programmatic and funding challenges.
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Teri
authors.initials: T
authors.lastname: Roberts
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cohn
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Bonner
authors.affiliation: International Health Unit, Department of Medicine, Section of Infectious Diseases and Immunity, Imperial College London, United Kingdom.
authors.forename: Sally
authors.initials: S
authors.lastname: Hargreaves
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016903:Drug Monitoring; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D006284:Health Plan Implementation; D006295:Health Resources / Q000191:economics / Q000592:standards; D006801:Humans; D007194:India / Q000453:epidemiology; D019095:Point-of-Care Systems; D019562:Viral Load / Q000191:economics / Q000592:standards; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents
keywords: antiretroviral therapy; monitoring; resource-limited settings; viral load; virological