Background HIV viral load (VL) monitoring is critical for antiretroviral therapy (ART) management. Point-of-care (POC) VL testing has been reported to be feasible and preferred over standard of care (SOC) testing in many low- and middle-income country (LMIC) settings, where rapid results could improve patient outcomes. Methods The timeliness of receipt of VL results was evaluated as part of an open label randomized controlled trial among patients newly initiating ART assessing clinical outcomes with POC VL monitoring using Cepheid Xpert® versus SOC VL at Jos University Teaching Hospital (JUTH) and Comprehensive Health Centre Zamko (CHCZ), in Nigeria. We determined the median number of days between specimen collection and recording of VL results in patient charts, patient receipt of results, and ART switch for those meeting virologic failure criteria. Results Between April 2018 and October 2019, we screened 696 ART-naïve individuals; 273 were randomized to POC and 268 to SOC HIV-1 VL testing. Participants in the POC arm received VL results significantly faster than those in the SOC arm (0.1 median days [IQR:0.1-0.2] versus 143.1 median days [IQR:56.0-177.1], respectively; p < 0.0001). Participants in the POC arm with confirmed virologic failure versus those in the SOC arm were switched more rapidly to a second-line regimen (0 median days [IQR:0-28] versus 66 days [IQR:63-123], respectively; p = 0.03). Conclusions POC VL testing resulted in significant improvement in the timeliness of VL result receipt by patients and use for effective HIV clinical management. In patients experiencing VL failure, POC monitoring enabled prompt switching to second-line ART regimens.

中文翻译：

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护理点病毒载量结果的及时性改善了尼日利亚的艾滋病毒监测


背景 HIV 病毒载量 (VL) 监测对于抗逆转录病毒治疗 (ART) 管理至关重要。据报道，在许多低收入和中等收入国家 (LMIC) 环境中，护理点 (POC) VL 测试是可行的，并且比护理标准 (SOC) 测试更受青睐，在这些国家，快速获得结果可以改善患者的治疗结果。方法 作为开放标签随机对照试验的一部分，对新开始 ART 的患者接受 VL 结果的及时性进行评估，在乔斯大学教学医院 (JUTH) 和综合健康中心使用 Cepheid Xpert® 与 SOC VL 进行 POC VL 监测评估临床结果Zamko (CHCZ)，尼日利亚。我们确定了样本采集和在患者图表中记录 VL 结果、患者收到结果以及满足病毒学失败标准的 ART 转换之间的中位天数。结果 2018 年 4 月至 2019 年 10 月期间，我们筛查了 696 名未接受过 ART 的个体； 273 名患者被随机分配至 POC，268 名患者被随机分配至 SOC HIV-1 VL 检测。 POC 组的参与者收到 VL 结果的速度明显快于 SOC 组的参与者（分别为 0.1 中位天数 [IQR：0.1-0.2] 和 143.1 中位天数 [IQR：56.0-177.1]；p < 0.0001）。与 SOC 组中确认病毒学失败的 POC 组参与者相比，SOC 组中的参与者更快地转为二线治疗方案（中位时间分别为 0 天 [IQR：0-28] 和 66 天 [IQR：63-123]；p = 0.03）。结论 POC VL 检测显着提高了患者收到 VL 结果的及时性并用于有效的 HIV 临床管理。对于经历 VL 衰竭的患者，POC 监测能够迅速切换到二线 ART 方案。