Susan P. Buchbinder
SEATTLE — Study results presented at CROI showed that point-of-care viral load testing in patients on ART can significantly improve their rate of viral suppression and retention in care.
Globally, just 47% of people living with HIV are virally suppressed, and many are not sufficiently retained in care. According to Paul Drain, MD, MPH, infectious disease specialist at the University of Washington and Harborview Medical Center in Seattle, one major reason is the long time it takes to obtain viral load test results from a laboratory.
In a randomized controlled trial conducted in Durban, South Africa, Drain and colleagues evaluated point-of-care viral load testing in adult patients already receiving ART to see if it would improve HIV outcomes. They randomly assigned 390 participants in a 1:1 ratio to receive either point-of-care HIV viral load testing, in which they received their results on the same day, or lab-based testing, which is the standard of care.
According to Drain and colleagues, the intervention increased the proportion of patients who were virally suppressed and retained in care after 12 months by close to 14% over standard-of-care testing — 89.7% vs. 75.9%. Broken up, the data showed that point-of-care testing increased viral load suppression by around 10%, from 83.1% to 93.3%, and increased retention in care by almost 8%, from 84.6% to 92.3%, the researchers reported.
Almost all — 99.5% — of patients in the intervention arm received a viral load result on the same day, whereas 74.7% of participants in the standard-of-care arm received results a median of 41 days after blood draw.
Susan P. Buchbinder, MD, director of Bridge HIV, an HIV prevention research unit in the San Francisco Department of Public Health, and a clinical professor of medicine, epidemiology and biostatistics at the University of California, San Francisco, said point-of-care testing could have some benefit in the United States.
“The issue is trying to capture people early ... who are not virally suppressed so that you can [conduct] more interventions,” said Buchbinder, who was not involved in the study.
“More information is usually better,” she said. “For instance, the Dean Street clinic in London has a lot of point-of-care testing that really makes it very accessible for people who come in. They [use point-of-care tests for STIs] and get their results right away. Then you can intervene immediately. The more we can move toward point-of-care testing, the better.”
Drain said point-of-care viral load testing helps physicians “identify those people who are having problems right away.”
“Those are the people that we want to identify quickly before they leave the clinic because, whether it’s in South Africa or in Seattle or somewhere else, as soon as they leave the clinic — and I’m talking about those people who are having challenges with their therapy — it’s very hard to reach them. It’s hard to get them back. So, the more that we can do point-of-care testing, particularly for viral loads [and] potentially eventually for resistance testing or other reasons, the better we can intervene and achieve viral suppression.” – by Gerard Gallagher
Drain P, et al. Abstract 53LB. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.
UNAIDS. Global HIV & AIDS statistics — 2018 fact sheet. http://www.unaids.org/en/resources/fact-sheet. Accessed March 6, 2019.
Disclosures: Buchbinder reports receiving medicine or equipment from Gilead Sciences for her institution. Drain reports no relevant financial disclosures.