Delays in repeat HIV viral load testing for those with elevated viral loads: a national perspective from South Africa.
HIV
cohort
laboratory testing
monitoring
retention
viral load
viral suppression
Journal
Journal of the International AIDS Society
ISSN: 1758-2652
Titre abrégé: J Int AIDS Soc
Pays: Switzerland
ID NLM: 101478566
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
18
09
2019
revised:
24
01
2020
accepted:
30
04
2020
entrez:
9
7
2020
pubmed:
9
7
2020
medline:
13
5
2021
Statut:
ppublish
Résumé
In South Africa, HIV patients with an elevated viral load (VL) should receive repeat VL testing after adherence counselling. We set out to use a national HIV Cohort to describe time to repeat viral load testing across South Africa and identify predictors of time to repeat testing. We conducted a cohort study of prospectively collected laboratory data. HIV treatment guidelines have changed over time in South Africa, but call for repeat VL testing within six months if 400 to 1000 copies/mL and two to three months if >1000 copies/mL. We included patients with suppressed viral loads (indicating they are on ART) and a first elevated VL (>400 copies/mL) between April 2004 and December 2014. Follow-up began at first elevated VL and continued until repeat testing, loss to follow-up or December 2016. We calculated adjusted hazard ratios (aHR) using Cox proportional hazard models. Of 371,648 patients with a VL > 400, 83.9% (311,790) had a repeat VL, in a median (IQR) of 7.0 (4.1 to 12.2) months. Of those with a first viral load 400 to 1000 copies/mL, 56.4% had a repeat VL within guideline recommended six months (defined as up to nine months), whereas among those >1000 copies/mL only 47.7% had a repeat viral load within guideline recommended two to three months (defined as up to six months). We found a small increase in repeat testing associated with higher VL value (aHR 1.11; 95% CI: 1.10 to 1.12 comparing >1000 vs 400 to 1000 copies/mL) and very low CD4 counts at first elevated VL (aHR 1.16; 95% CI: 1.13 to 1.19 comparing CD4 < 50 vs <500 cells/mm Median time to repeat viral load testing for those with an elevated viral load was longer than guidelines recommend. Future work should identify whether delays are due to patient or provider factors.
Identifiants
pubmed: 32640101
doi: 10.1002/jia2.25542
pmc: PMC7343337
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25542Subventions
Organisme : NIDDK NIH HHS
ID : K01 DK116929
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI115979
Pays : United States
Organisme : NIMH NIH HHS
ID : 1K01MH105320-01A1
Pays : United States
Organisme : NIAID NIH HHS
ID : 1R01AI115979-01
Pays : United States
Informations de copyright
© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.
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