Abstract
The benefits of antiretroviral therapy (ART) in patients living with HIV (PLWH) in Nepal have been obvious. However, their viral load (VL) and the effects of VL testing scale-up on the outcomes of HIV treatment have not been adequately investigated. In Nepal, VL tests were performed since 2009 at National Public Health laboratory. VL testing for monitoring scale up was introduced in 2014. The present study was undertaken to find out the virological failure (VF) and virological suppression (VS) rates in PLWH on ART in Nepal and to assess the effect of VL testing coverage on ART outcomes. A total of 8,230 blood/plasma samples were collected from among 11,922 patients on ART during 2009 to 2015. The VL testing coverage in 2009 was 2.9% which increased to 48.3% in 2015. VF was 35.9% in 2009 (mean for 2009-2013 was 27.5% and for 2014-2015 the mean VF was 10.2%). Decrease in VF to nearly one third in 2015 coincided with the rise in VL testing coverage (from 2.9 to 48.3%). Improvement in VL testing coverage for ART monitoring coincided with decline in VF, indicative of ART optimization. VL testing of ART treatment failure cases only in the first segment of the study (2009-2013), accounted for initial low VL coverage. However, 48.3% coverage in the last year of scale-up period, with a mean VF of 10.2% and nearly 90% of all those receiving ART having VS, was very encouraging. Key words: Viral load testing, Nepal, outcomes.
Highlights
The quantity of human immunodeficiency virus (HIV) ribonucleic acid (RNA) in plasma can be measured accurately by plasma viral load testing (Mylonakis et al, 2001), which is the gold standard practice in resource-rich countries for detecting treatment failure among people receiving antiretroviral therapy (ART) (World Health Organization, 2014)
Twenty-five (25) ART centers located at various parts of the country provided treatment to patients living with HIV (PLWH) in Nepal, following the National Centre for AIDS and STD Control and National ART Guidelines (2009) and National consolidated Guideline for Treating and Preventing HIV in Nepal (Government of Nepal Ministry of Health and Population, 2014)
During 2009-2013, viral load (VL) testing was done for ART treatment monitoring as on-request testing for referred (ART treatment failure) cases whereas, from 2014, testing was done as part of scale up VL testing program after completion of first six months of ART, for treatment monitoring, as recommended in the National consolidated Guideline for Treating and Preventing HIV in Nepal (2014)
Summary
The quantity of human immunodeficiency virus (HIV) RNA in plasma can be measured accurately by plasma viral load testing (Mylonakis et al, 2001), which is the gold standard practice in resource-rich countries for detecting treatment failure among people receiving ART (World Health Organization, 2014). It has been recommended by World Health Organization (WHO, 2014) as a preferred tool for diagnosing and confirming the failure of antiretroviral therapy (ART) (World Health Organization, 2013a) and has become the cornerstone of HIV disease management. VL testing for monitoring scaleup was introduced in 2014 and thereafter; VL testing was done after completion of the first six months of ART treatment and subsequently when indicated
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