Sustainable HIV treatment in Africa through viral-load-informed differentiated care

Andrew Phillips; Amir Shroufi; Lara Vojnov; Jennifer Cohn; Teri Roberts; Tom Ellman; Kimberly Bonner; Christine Rousseau; Geoff Garnett; Valentina Cambiano; Fumiyo Nakagawa; Deborah Ford; Loveleen Bansi-Matharu; Alec Miners; Jens D Lundgren; Jeffrey W Eaton; Rosalind Parkes-Ratanshi; Zachary Katz; David Maman; Nathan Ford; Marco Vitoria; Meg Doherty; David Dowdy; Brooke Nichols; Maurine Murtagh; Meghan Wareham; Kara M Palamountain; Christine Chakanyuka Musanhu; Wendy Stevens; David Katzenstein; Andrea Ciaranello; Ruanne Barnabas; R Scott Braithwaite; Eran Bendavid; Kusum J Nathoo; David van de Vijver; David P Wilson; Charles Holmes; Anna Bershteyn; Simon Walker; Elliot Raizes; Ilesh Jani; Lisa J Nelson; Rosanna Peeling; Fern Terris-Prestholt; Joseph Murungu; Tsitsi Mutasa-Apollo; Timothy B Hallett; Paul Revill; Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa

doi:10.1038/nature16046

Sustainable HIV treatment in Africa through viral-load-informed differentiated care

Andrew Phillips, Amir Shroufi, Lara Vojnov, Jennifer Cohn, Teri Roberts, Tom Ellman, Kimberly Bonner, Christine Rousseau, Geoff Garnett, Valentina Cambiano, Fumiyo Nakagawa, Deborah Ford, Loveleen Bansi-Matharu, Alec Miners, Jens D Lundgren, Jeffrey W Eaton, Rosalind Parkes-Ratanshi, Zachary Katz, David Maman, Nathan FordMarco Vitoria, Meg Doherty, David Dowdy, Brooke Nichols, Maurine Murtagh, Meghan Wareham, Kara M Palamountain, Christine Chakanyuka Musanhu, Wendy Stevens, David Katzenstein, Andrea Ciaranello, Ruanne Barnabas, R Scott Braithwaite, Eran Bendavid, Kusum J Nathoo, David van de Vijver, David P Wilson, Charles Holmes, Anna Bershteyn, Simon Walker, Elliot Raizes, Ilesh Jani, Lisa J Nelson, Rosanna Peeling, Fern Terris-Prestholt, Joseph Murungu, Tsitsi Mutasa-Apollo, Timothy B Hallett, Paul Revill, Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa

Institut for Klinisk Medicin

106 Citationer (Scopus)

Abstract

There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

Originalsprog	Engelsk
Tidsskrift	Nature
Vol/bind	528 Suppl.
Udgave nummer	7580
Sider (fra-til)	S68-S76
ISSN	0028-0836
DOI	https://doi.org/10.1038/nature16046
Status	Udgivet - 2 dec. 2015

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Phillips, A., Shroufi, A., Vojnov, L., Cohn, J., Roberts, T., Ellman, T., Bonner, K., Rousseau, C., Garnett, G., Cambiano, V., Nakagawa, F., Ford, D., Bansi-Matharu, L., Miners, A., Lundgren, J. D., Eaton, J. W., Parkes-Ratanshi, R., Katz, Z., Maman, D., ... Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa (2015). Sustainable HIV treatment in Africa through viral-load-informed differentiated care. Nature, 528 Suppl.(7580), S68-S76. https://doi.org/10.1038/nature16046

Phillips, A, Shroufi, A, Vojnov, L, Cohn, J, Roberts, T, Ellman, T, Bonner, K, Rousseau, C, Garnett, G, Cambiano, V, Nakagawa, F, Ford, D, Bansi-Matharu, L, Miners, A, Lundgren, JD, Eaton, JW, Parkes-Ratanshi, R, Katz, Z, Maman, D, Ford, N, Vitoria, M, Doherty, M, Dowdy, D, Nichols, B, Murtagh, M, Wareham, M, Palamountain, KM, Chakanyuka Musanhu, C, Stevens, W, Katzenstein, D, Ciaranello, A, Barnabas, R, Braithwaite, RS, Bendavid, E, Nathoo, KJ, van de Vijver, D, Wilson, DP, Holmes, C, Bershteyn, A, Walker, S, Raizes, E, Jani, I, Nelson, LJ, Peeling, R, Terris-Prestholt, F, Murungu, J, Mutasa-Apollo, T, Hallett, TB, Revill, P & Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa 2015, 'Sustainable HIV treatment in Africa through viral-load-informed differentiated care', Nature, bind 528 Suppl., nr. 7580, s. S68-S76. https://doi.org/10.1038/nature16046

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title = "Sustainable HIV treatment in Africa through viral-load-informed differentiated care",

abstract = "There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.",

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author = "Andrew Phillips and Amir Shroufi and Lara Vojnov and Jennifer Cohn and Teri Roberts and Tom Ellman and Kimberly Bonner and Christine Rousseau and Geoff Garnett and Valentina Cambiano and Fumiyo Nakagawa and Deborah Ford and Loveleen Bansi-Matharu and Alec Miners and Lundgren, {Jens D} and Eaton, {Jeffrey W} and Rosalind Parkes-Ratanshi and Zachary Katz and David Maman and Nathan Ford and Marco Vitoria and Meg Doherty and David Dowdy and Brooke Nichols and Maurine Murtagh and Meghan Wareham and Palamountain, {Kara M} and {Chakanyuka Musanhu}, Christine and Wendy Stevens and David Katzenstein and Andrea Ciaranello and Ruanne Barnabas and Braithwaite, {R Scott} and Eran Bendavid and Nathoo, {Kusum J} and {van de Vijver}, David and Wilson, {David P} and Charles Holmes and Anna Bershteyn and Simon Walker and Elliot Raizes and Ilesh Jani and Nelson, {Lisa J} and Rosanna Peeling and Fern Terris-Prestholt and Joseph Murungu and Tsitsi Mutasa-Apollo and Hallett, {Timothy B} and Paul Revill and {Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa}",

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AU - Phillips, Andrew

AU - Shroufi, Amir

AU - Vojnov, Lara

AU - Cohn, Jennifer

AU - Roberts, Teri

AU - Ellman, Tom

AU - Bonner, Kimberly

AU - Rousseau, Christine

AU - Garnett, Geoff

AU - Cambiano, Valentina

AU - Nakagawa, Fumiyo

AU - Ford, Deborah

AU - Bansi-Matharu, Loveleen

AU - Miners, Alec

AU - Lundgren, Jens D

AU - Eaton, Jeffrey W

AU - Parkes-Ratanshi, Rosalind

AU - Katz, Zachary

AU - Maman, David

AU - Ford, Nathan

AU - Vitoria, Marco

AU - Doherty, Meg

AU - Dowdy, David

AU - Nichols, Brooke

AU - Murtagh, Maurine

AU - Wareham, Meghan

AU - Palamountain, Kara M

AU - Chakanyuka Musanhu, Christine

AU - Stevens, Wendy

AU - Katzenstein, David

AU - Ciaranello, Andrea

AU - Barnabas, Ruanne

AU - Braithwaite, R Scott

AU - Bendavid, Eran

AU - Nathoo, Kusum J

AU - van de Vijver, David

AU - Wilson, David P

AU - Holmes, Charles

AU - Bershteyn, Anna

AU - Walker, Simon

AU - Raizes, Elliot

AU - Jani, Ilesh

AU - Nelson, Lisa J

AU - Peeling, Rosanna

AU - Terris-Prestholt, Fern

AU - Murungu, Joseph

AU - Mutasa-Apollo, Tsitsi

AU - Hallett, Timothy B

AU - Revill, Paul

AU - Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa

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N2 - There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

AB - There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

KW - Adolescent

KW - Adult

KW - Africa

KW - Aged

KW - Anti-HIV Agents

KW - Cost-Benefit Analysis

KW - HIV Infections

KW - Humans

KW - Middle Aged

KW - Precision Medicine

KW - Viral Load

KW - Young Adult

U2 - 10.1038/nature16046

DO - 10.1038/nature16046

M3 - Journal article

C2 - 26633768

SN - 0028-0836

VL - 528 Suppl.

SP - S68-S76

JO - Nature

JF - Nature

IS - 7580

ER -

Sustainable HIV treatment in Africa through viral-load-informed differentiated care

Abstract

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