Sustainable HIV treatment in Africa through viral-load-informed differentiated care
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Sustainable HIV treatment in Africa through viral-load-informed differentiated care. / Phillips, Andrew; Shroufi, Amir; Vojnov, Lara; Cohn, Jennifer; Roberts, Teri; Ellman, Tom; Bonner, Kimberly; Rousseau, Christine; Garnett, Geoff; Cambiano, Valentina; Nakagawa, Fumiyo; Ford, Deborah; Bansi-Matharu, Loveleen; Miners, Alec; Lundgren, Jens D; Eaton, Jeffrey W; Parkes-Ratanshi, Rosalind; Katz, Zachary; Maman, David; Ford, Nathan; Vitoria, Marco; Doherty, Meg; Dowdy, David; Nichols, Brooke; Murtagh, Maurine; Wareham, Meghan; Palamountain, Kara M; Chakanyuka Musanhu, Christine; Stevens, Wendy; Katzenstein, David; Ciaranello, Andrea; Barnabas, Ruanne; Braithwaite, R Scott; Bendavid, Eran; Nathoo, Kusum J; van de Vijver, David; Wilson, David P; Holmes, Charles; Bershteyn, Anna; Walker, Simon; Raizes, Elliot; Jani, Ilesh; Nelson, Lisa J; Peeling, Rosanna; Terris-Prestholt, Fern; Murungu, Joseph; Mutasa-Apollo, Tsitsi; Hallett, Timothy B; Revill, Paul; Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa.
In: Nature, Vol. 528 Suppl., No. 7580, 03.12.2015, p. S68-S76.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Sustainable HIV treatment in Africa through viral-load-informed differentiated care
AU - Phillips, Andrew
AU - Shroufi, Amir
AU - Vojnov, Lara
AU - Cohn, Jennifer
AU - Roberts, Teri
AU - Ellman, Tom
AU - Bonner, Kimberly
AU - Rousseau, Christine
AU - Garnett, Geoff
AU - Cambiano, Valentina
AU - Nakagawa, Fumiyo
AU - Ford, Deborah
AU - Bansi-Matharu, Loveleen
AU - Miners, Alec
AU - Lundgren, Jens D
AU - Eaton, Jeffrey W
AU - Parkes-Ratanshi, Rosalind
AU - Katz, Zachary
AU - Maman, David
AU - Ford, Nathan
AU - Vitoria, Marco
AU - Doherty, Meg
AU - Dowdy, David
AU - Nichols, Brooke
AU - Murtagh, Maurine
AU - Wareham, Meghan
AU - Palamountain, Kara M
AU - Chakanyuka Musanhu, Christine
AU - Stevens, Wendy
AU - Katzenstein, David
AU - Ciaranello, Andrea
AU - Barnabas, Ruanne
AU - Braithwaite, R Scott
AU - Bendavid, Eran
AU - Nathoo, Kusum J
AU - van de Vijver, David
AU - Wilson, David P
AU - Holmes, Charles
AU - Bershteyn, Anna
AU - Walker, Simon
AU - Raizes, Elliot
AU - Jani, Ilesh
AU - Nelson, Lisa J
AU - Peeling, Rosanna
AU - Terris-Prestholt, Fern
AU - Murungu, Joseph
AU - Mutasa-Apollo, Tsitsi
AU - Hallett, Timothy B
AU - Revill, Paul
AU - Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa
PY - 2015/12/3
Y1 - 2015/12/3
N2 - There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.
AB - There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.
KW - Adolescent
KW - Adult
KW - Africa
KW - Aged
KW - Anti-HIV Agents
KW - Cost-Benefit Analysis
KW - HIV Infections
KW - Humans
KW - Middle Aged
KW - Precision Medicine
KW - Viral Load
KW - Young Adult
U2 - 10.1038/nature16046
DO - 10.1038/nature16046
M3 - Journal article
C2 - 26633768
VL - 528 Suppl.
SP - S68-S76
JO - Nature
JF - Nature
SN - 0028-0836
IS - 7580
ER -
ID: 162413806