Undetectable: How Viral Load Monitoring Can Improve HIV Treatment in Developing Countries
An updated version of this report is now available:
Putting HIV and HCV to the Test: A Product Guide for Point-of-Care CD4 and Laboratory-Based and Point-of-Care Virological HIV and HCV Tests.
Today, eight million people in developing countries have access to HIV therapy and while many more need to be reached with life-saving medicines, this is important progress. However, the monitoring that goes hand in hand with HIV treatment is still lagging behind in developing countries.
The tool used for HIV monitoring in resource-limited settings today is a measurement of people’s CD4 white blood cell count, which does not paint an accurate enough picture of how a person is responding to treatment.
The best monitoring tool is viral load (VL) testing, which measures the amount of virus in the blood. It is used routinely in developed countries, but reserved only for limited uses in a few developing countries, owing to cost and complexity. Viral load testing prevents doctors from unnecessarily switching patients to more expensive drugs or leaving them to continue on ineffective therapy that can lead to drug resistance and ultimately death.
Viral load testing:
helps identify people who may be having trouble sticking to their treatment and need support
helps identify those who are failing their treatment because the virus has become resistant to the drugs they are taking and who need to be switched to another treatment regimen
This report by Médecins Sans Frontières (MSF) seeks to identify the next steps to improving access to viral load testing in resource-limited settings, by:
Describing the importance of viral load monitoring
Assessing the current state of play in terms of implementation of viral load testing in the developing world
Exploring how to overcome technical barriers by looking at the research and development (R&D) pipeline and defining the ideal specifications of a viral load test for resourcelimited settings
Identifying strategies to overcome market barriers in order to make viral load monitoring more affordable.
With complexity and cost acting as the largest barriers to scale up, there is an urgent need to push forward the development and field validation of simple and affordable laboratory-based and point-of-care viral load tests.