Near point-of-care HIV viral load testing: cascade after high viral load in suburban Yangon, Myanmar

Journal article

Introduction: HIV viral load (VL) testing in resource-limited settings is often centralised, limiting access. In Myanmar, we assessed outcomes according to VL access and the VL cascade (case management after a first high VL result) before and after near point-of-care (POC) VL was introduced.

Methods: Routine programme data from people living with HIV (PLHIV) on antiretroviral therapy (ART) were used. We assessed the odds of getting a VL test done by year. Attrition and mortality two years after ART initiation were compared between three groups of PLHIV with different access to VL testing using Kaplan-Meier analysis. We compared VL cascades in those with a first VL result before and after near POC VL testing became available. With logistic regression, predictors of confirmed virological failure after a first high VL in the POC era were explored.

Results: Among 4291 PLHIV who started ART between July 2009 and June 2018, 794 (18.5%) became eligible for VL testing when it was not available, 2388 (55.7%) when centralised laboratory-based VL testing was available, and 1109 (25.8%) when near POC VL testing was available. Between 2010 and 2019, the odds of getting a VL test among those eligible increased with each year (OR: 5.21 [95% CI: 4.95–5.48]). Attrition and mortality were not different in the three groups. When comparing PLHIV with a first VL result before and after implementation of the near POC VL testing, in the latter, more had a first VL test (92% versus 15%, p<0.001), less had a first high VL result (5% versus 14%, p<0.001), and more had confirmed virological failure (67% versus 47%, p = 0.013). Having a first VL ≥5000 copies/mL after near POC implementation was associated with confirmed virological failure (adjusted OR: 2.61 [95% CI: 1.02–6.65]).

Conclusion: Near POC VL testing enabled rapid increase of VL coverage and a well-managed VL cascade in Myanmar.

Authors: Tun, NN; Smithuis, F; Tun, NL; Min, M; Hlaing, MMM

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Public Library of Science
• Journal: PLoS ONE
• Volume: 18
• Issue: 4
• Article number: e0272673
• Place of publication: United States
• Publication date: 2023-04-13
• Acceptance date: 2023-02-10
• DOI: 10.1371/journal.pone.0272673
• EISSN: 1932-6203
• Pmid: 37053171
• Language: English
• Keywords: serologic tests; viral load; point-of-care testing; anti-HIV agents; Myanmar; point-of-care systems; HIV infections