As the number of people receiving HIV treatment continues to rise – 6.6 million people were taking antiretroviral drugs by December 2010 – it is important to ensure the technology to test and monitor patients on ARVs be made simpler, cheaper and more easily available to high prevalence, low-income countries, say experts.
A new report by the international HIV financing mechanism, UNITAID, charts the landscape of HIV diagnostics available and outlines tools in the pipeline, making the case that point-of-care technologies are crucial to any effective treatment strategy.
The three major diagnostic tools for HIV are the antibody test – now cheaply and widely available as a rapid test – the CD4 test, which measures immune strength, and the viral-load test. In low-income countries, CD4 and viral-load testing is often conducted in central laboratories far from rural areas, and patients sometimes wait weeks for results.
Access to HIV testing is well developed, but beyond that, progress still needs to be made in… CD4 testing and viral-load testing,” said Maurine Murtaugh, author of the UNITAID report and diagnostics expert.
“Viral-load testing is very important because the more millions we have on treatment, the more important it becomes to be able to determine early on when treatment is failing, especially because as the viral load increases, so does the risk of infecting others,” she added.
Murtaugh noted that so far, cost had been the major issue hindering countries from providing access to their HIV-infected populations, but designers of the new technologies were working to keep costs down. She added that the first disposable CD4 test could be on the market as early as 2013.
“In Kenya, for example, there are only three centres nationally that can test infants… for HIV, viral load and CD4 count,” said Andrew Suleh, medical superintendent at Mbagathi District Hospital in the Kenyan capital, Nairobi. “This is because the expensive and sophisticated technology is required that the country cannot afford and also there are not enough trained personnel to operate this kind of technology.
“Rural areas are particularly disadvantaged because of poor transport and communication networks, which make it difficult to transport test samples and communicate results, creating delays and leading to late initiation of HIV-positive infants on treatment,” he added.
Murtaugh noted that the long delays between testing and receiving results often made health centres lose patients diagnosed positive and needing treatment. “Anecdotal evidence shows that early use of new point-of-care technology has vastly improved retention of patients in treatment programmes,” she said.
Suleh said point-of-care technology would have an especially significant impact on HIV treatment programmes for children.
“If you have a simple yet effective point-of-care diagnosis of infants then poor countries would be able to scale up treatment because it means an increment in the number of infants being diagnosed and initiated on treatment,” he said. “It also gives accurate data on the number of children who need treatment, and hence, ease in planning and budgeting. As things stand today, paediatric treatment of HIV is lagging behind [adults] because of these difficulties.”