The Importance of Regular Viral Load Testing in HIV-Positive Individuals

The 90-90-90 goal from the Joint UN Programme on HIV/AIDS (UNAIDS) has three prongs: By 2020, 90% of people with HIV worldwide will be aware of their status; 90% of HIV-positive (+) people will have access to treatment; and 90% of those with HIV will have a suppressed viral load. To meet this challenge, one of the many things that must be improved is access to routine viral load testing, particularly in low-resource settings such as sub-Saharan Africa, where 70% of people with HIV live. More than 6 million HIV+ people in sub-Saharan Africa who receive antiretroviral therapy have no access to viral load testing, which is crucial in order for clinicians to identify treatment failures and switch patients to a second- or third-line drug before the disease progresses. Currently, more than 10 million viral load tests annually are needed worldwide, a number which may grow to 30 million tests annually by 2020.

A team of researchers from the Centers for Diseases Control and Prevention and partners in healthcare organizations around the world have issued a report outlining the main obstacles to accessible viral load testing and how to overcome them. At the top of the list is the need for a large investment of money that will enable more testing laboratories, supplies, and associated clinical costs, with a focus on the high expense associated with second-line and third-line treatment regimens. “Although viral load testing could lead to eventual cost savings on the basis of improved patient outcomes, reductions in unnecessary regimen switches, and reduced transmission, budget planning for increased investment in the short term will be necessary to ensure that these costs do not become barriers to testing scale-up,” the authors write. “Additionally, increased efforts to improve access to viral load testing should be accompanied by efforts to improve access to effective and affordable second-line and third-line regimens.”

The researchers recognize the need to secure better pricing for viral load tests going forward. Options include cost reductions based on volume discounts or consortium buying, both for the tests themselves and for instruments used to process the tests. As an example, they mention that several major test procurers recently partnered to obtain a 40% discount with a viral load test supplier, resulting in a net price of less than $10 per test. The ability to enter into such agreements depends on having good forecast models that predict test demand, costs, and sustainable patterns of test purchasing. Also on the researchers’ list is the need for functional and efficient laboratory networks that can assure test availability to everybody from the most centrally located citizens to those in more far-flung areas (which may be serviced with mobile testing units). Having a centralized network will help ensure that all tests are processed in a timely and efficient manner. Also important is simplifying the testing process with new technologies such as the use of dried blood spots in lieu of fresh plasma samples--a seemingly small step, but one that can enable rural patients to get the testing they need in areas where blood sample collection and preservation techniques may not be optimal.

Recognizing that medical errors can greatly affect patient health, the study’s authors assert that viral load tests need to be of the highest quality possible, involving adherence to registration and regulatory requirements and a commitment to quality assurance, data management, instrument maintenance, and laboratory accreditation. The authors note that not all laboratories meet quality standards, which they want to rectify.

While the study authors assert that all governments need to be fully invested in and onboard with taking the steps necessary to achieve near-universal viral load testing, the onus is not all on them. The authors claim that viral load monitoring can be successful only if patients and medical professionals work together to demand the tests when necessary. Currently, the researchers say, demand for viral load testing worldwide is low, perhaps because doctors, nurses and patients themselves are unaware of the need for regular testing and may lack the education necessary to interpret the results. Proper training will enable clinicians to recommend the correct therapies for their HIV patients and will empower patients to manage their disease in partnership with healthcare providers. And as proper management of HIV often results in better management of other existing diseases and disease threats, a commitment to better HIV testing protocols can result in a country’s better overall health.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.