Fresh push for HIV viral load monitoring

HARARE - Government must scale-up the use of “viral load”-based HIV treatment monitoring to improve treatment outcomes, an international medical humanitarian organisation, Médecins Sans Frontières (MSF), has said.

Zimbabwe’s health sector is presently relying on CD4 count — which is considerably cheaper than viral load tests — to treat an estimated 600 000 people on antiretroviral drugs (ARVs), according to National Aids Council.

In a statement issued yesterday, MSF said the Global Fund to Fight Aids, Tuberculosis and Malaria and the United States President’s Emergency Plan for Aids Relief (Pepfar) programme — the two main funders of global HIV treatment — should promptly use their large purchasing power to negotiate for lower prices for viral load tests.

“Viral load is much more accurate at detecting problems than CD4 testing, which is commonly used today, and it can also prevent people from being unnecessarily switched to more expensive ‘second-line’ medicines,” said MSF head of mission in Zimbabwe, Fasil Tezera.

“Ideally, viral load testing confirms the level of HIV in a person’s blood is ‘undetectable,’ which means antiretroviral medicines have suppressed the virus maximally. This is the best for their own health and also for their communities, as undetectable HIV is very unlikely to be transmitted to others,” he said.

The lobbying gained momentum during the four-day International Conference on Aids and STIs in Africa (Icasa) which ended on Tuesday in Cape Town, South Africa where MSF reported on new findings on the benefits of viral load monitoring for people on antiretroviral therapy and strategies to reduce the costs.

The research claims that the estimated cost of manufacturing materials used for a viral test ranges from $1,61 to $4,50 for the three most commonly used tests in Africa but they are sold for prices ranging from $11 to $55.

MSF suggests, through pooled procurement, the price could be as low as $7 or less, per test.

“It is the gold standard for treatment monitoring, but it is largely unavailable in developing countries because cost is a major factor,” said MSF South Africa medical coordinator Gilles van Cutsem, adding:
“Prices need to come down so that countries can scale up, and new research shows this is possible.”

A 2012 MSF survey of 23 resource-limited countries showed that while virtually all countries included viral load monitoring in their treatment guidelines, it was available in only four.

The latest WHO/ HIV treatment guidelines call for people to receive a viral load test once a year.

This allows the switching of clients to favourable drugs. But the country is still struggling to provide repeat CD4 count to ART clients, providing clinical management instead.

Findings from the viral load study done in Kenya, Malawi and Zimbabwe sampling unresponsive ART clients on clinical signs or immunological criteria (CD4 testing) alone, show only 30 percent actually had an elevated viral load.

The remaining 70 percent of the people could have been switched unnecessarily to second-line treatment, if viral load had not subsequently been used.

The ministry’s Aids and TB director Owen Mugurungi was unreachable for comment.

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