Photo: An MSF staff member uses a SAMBA tool for rapid viral load monitoring. Malawi 2011 © Nabila Kram
MSF Research Points to Ways to Expand Viral Load Testing for HIV in Developing Countries
“Viral load monitoring—a test that measures the amount of virus in a person’s blood and thus the effectiveness of antiretroviral treatment—is critical in allowing treatment failure to be detected earlier, and ensuring that people receive the support they need to adhere to treatment,” said Dr. Jennifer Cohn, medical coordinator for MSF’s Access Campaign. “It’s a standard part of HIV disease management in developed countries but due to high costs and the lack of suitable technology, this type of virological monitoring is almost non-existent in developing countries. We need to challenge this state of affairs by ensuring there is financial and political support for roll-out of viral load in remote settings as a routine part of decentralized care.”
The two main barriers to roll-out of viral load concern the cost of testing and the difficulties of sample collection and transport. In two studies to be presented at CROI from its projects in Thyolo, Malawi, MSF will show how viral load monitoring can be adapted for resource-limited settings by using novel technologies and strategies to address these barriers.
The first study looked at simplification. Instead of conducting a blood draw, which requires a nurse, MSF was able to acquire blood samples by performing a simple finger-prick in order to prepare dried blood spots, which were then transported to a laboratory with viral load testing capabilities. Because dried blood spots (DBS) are easy to prepare, extremely stable at room temperature, and can even be sent in the mail, the finger-prick method of collecting samples in conjunction with the practicality of using DBS helps to overcome the challenges of health worker shortages and lack of sophisticated sample transportation networks for blood-based samples. This makes access to viral load testing easier for patients in rural areas, who no longer need to travel long distances to reach facilities with testing capacity.
A second viral load study to be presented at CROI looked at overcoming cost barriers preventing routine viral load implementation. MSF evaluated the accuracy and cost-saving of pooling samples of dried blood spots compared to individual viral load testing in a rural district laboratory in Thyolo, Malawi.