Poor access to HIV viral load (VL) testing prevents the timely monitoring of HIV treatment adherence and efficacy. Factors enabling clinical benefits of VL testing when added to local standards of care, can inform the development of more cost-effective routine VL scale-up plans. We compared antiretroviral therapy (ART) switch practices in 13 clinics across 6 countries, with full (N = 8), phasing-in (N = 3) or no onsite access (N = 2) to VL. The analysis used data from the Pan-African Studies to Evaluate Resistance (PASER), observing virological and drug resistance outcomes among adults receiving first- or second-line ART between 2008 and 2015. Study plasma viral load (sVL) determined at baseline, every 12 months thereafter and at the time of switch served for retrospectively validating switch decisions, categorized into “necessary,” “unnecessary,” and “missed.” Virological failure was defined as two consecutive sVL ≥1,000 HIV-RNA copies/mL. One thousand nine hundred ninety-five of the 2,420 (82.4%) study participants had continuous virological suppression during the median 30 months of follow-up. Among the 266 virological failures (11.0%), the proportion of necessary switches were similar in clinics with full (37%), phasing-in (25%), or no access (39%) to local VL testing. Documented utilization of local VL results for the switch decision was associated with higher percentage of necessary switch (87.6% vs. 67.9%). Shorter time to necessary switch was associated with higher rates of long-term virological suppression, regardless of access to local viral load. Availability of HIV VL testing capacity does not systematically result in adequate switch practices or better virological outcomes. Systems supporting sufficient test demand execution, and actual utilization of results for patient management need strengthening.

中文翻译：

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获得 HIV 病毒载量检测和抗逆转录病毒疗法转换实践：撒哈拉以南非洲的多国前瞻性队列研究。

无法获得 HIV 病毒载量 (VL) 检测阻碍了对 HIV 治疗依从性和疗效的及时监测。将 VL 测试的临床益处添加到当地护理标准时，可以为制定更具成本效益的常规 VL 放大计划提供信息。我们比较了 6 个国家/地区 13 个诊所的抗逆转录病毒疗法 (ART) 转换实践，包括完全 ( N  = 8)、分阶段 ( N  = 3) 或无现场访问 ( N = 2) 到 VL。该分析使用了泛非耐药性评估研究 (PASER) 的数据，观察了 2008 年至 2015 年期间接受一线或二线 ART 的成年人的病毒学和耐药性结果。研究在基线时确定的血浆病毒载量 (sVL)，每个12 个月后和转换时用于追溯验证转换决定，分为“必要”、“不必要”和“错过”。病毒学失败定义为连续两次 sVL ≥ 1,000 HIV-RNA 拷贝/mL。2,420 名研究参与者中有 1,995 名 (82.4%) 在中位随访 30 个月期间持续病毒学抑制。在 266 例病毒学失败 (11.0%) 中，必要转换的比例在诊所中相似，完全 (37%)、分阶段 (25%)、或无法访问 (39%) 本地 VL 测试。用于转换决策的本地 VL 结果的记录利用率与更高百分比的必要转换相关（87.6% 对 67.9%）。无论是否获得局部病毒载量，更短的必要转换时间与更高的长期病毒学抑制率相关。HIV VL 检测能力的可用性并不能系统地导致适当的转换实践或更好的病毒学结果。支持充分执行测试需求和实际利用结果以进行患者管理的系统需要加强。无论是否获得局部病毒载量。HIV VL 检测能力的可用性并不能系统地导致适当的转换实践或更好的病毒学结果。支持充分执行测试需求和实际利用结果以进行患者管理的系统需要加强。无论是否获得局部病毒载量。HIV VL 检测能力的可用性并不能系统地导致适当的转换实践或更好的病毒学结果。支持充分执行测试需求和实际利用结果以进行患者管理的系统需要加强。