UNITAID greenlights proposal to implement POC CD4 tests and routine viral monitoring

May 10, 2012

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UNITAID greenlights proposal to implement POC CD4 tests and routine viral monitoring

UNITAID has agreed to fund an MSF proposal to implement point-of-care CD4 testing for initiating antiretroviral treatment and routine viral load testing for ART monitoring in eight MSF-supported HIV/AIDS programmes in Africa. The project is based on an intersectional proposal with three MSF operational centres (Brussels, Geneva and Paris) and the Access Campaign. The three-year US$ 28.7 million grant will be coordinated through OCB..

This is a major success for us and will vastly improve the quality of treatment follow- up for patients in our projects on ART. Read more about the project in this short interview with Teri Roberts, the Campaign’s Diagnostics Advisor.

What do we hope to achieve through this project?

We aim to demonstrate the feasibility, cost-effectiveness and positive effect on patient outcomes of radically decentralising viral load monitoring and CD4 testing from top level reference laboratories down to district level facilities – ie district laboratories, primary healthcare clinics and health centres - thus dramatically opening up access to these diagnostic services in the places where we work, and also opening up the market for tests that work successfully in these contexts.

What are the benefits we can hope to see?

There is a number of benefits we see flowing from ramping up virological monitoring in this way. Firstly, on an individual level, we expect better treatment outcomes for patients as we will be able to identify those whose viral load remains detectable despite antiretroviral treatment and who should then be offered adherence counselling. We will also be able to determine clearly through viral monitoring when a patient should switch treatment lines when, despite good adherence, viral load is still detectable in a patient, due to treatment failure.

As a result of this activity, we can hope to see an overall decrease in the number of cases of HIV, as the suppression of the virus in a patient, through adequate treatment, stops its transmission. Also as a result of improved adherence achieved through viral monitoring, we expect to see a decrease in the development of drug resistant mutations, which would result in the patient failing on treatment. This would allow more patients to stay on the current affordable and robust first-line treatments.

What results are we expecting from this project?

More than 207 000 patients will receive at least one viral load test during the three years of the project. It’s expected that as a result of this project, around 16 000 additional people are likely to switch to a second-line regimen; around 12 000 patients will be retained in care and not lost to follow-up; and between 3 500 and 4 000 lives will be saved as a result.

Where is it happening?

The project will be implemented in Lesotho (Maseru), Malawi (Thyolo and Chiradzulu), Mozambique (Maputo and Tete), South Africa (uThungulu), Swaziland (Shishelweni), Uganda (Arua) and Zimbabwe (Buhera, Gutu and Chicomba).

What happens next after the project has been implanted?

Once we have been able to demonstrate through our collection of data in the field, the feasibility, cost-effectiveness and positive changes in patient outcomes, we will then have an evidence-base from which to recommend which tests or combination of tests work best in which contexts. Also, by demonstrating feasibility in remote and resource-limited settings, we will create incentives for manufacturers to enter this market. By attracting a number of different manufacturers into the market, we hope to drive down the prices of the tests through increased competition.

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