Nav: Home

Shortfalls in laboratory services may limit attainment of worldwide targets for HIV

August 23, 2016

The Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets call for 90% of all people living with HIV to know their HIV status, 90% of all people diagnosed with HIV infection to receive antiretroviral therapy (ART), and 90% of those receiving ART to achieve durable viral suppression by the year 2020. In a study appearing in PLOS Medicine, Vincent Habiyambere of the World Health Organization (WHO) and colleagues find that insufficient capacity to perform laboratory tests used in monitoring HIV infection, and underutilization of existing testing capacity, are limiting the ability to meet these goals.

The researchers analyzed responses to annual surveys sent to WHO offices from 127 countries between 2012 and 2014. Respondents each reported on the capacity and usage of CD4 testing, HIV viral load (VL) testing, and early infant diagnosis in their country. The researchers found that the capacity of available CD4 instruments was sufficient to meet the demand of all people living with HIV/AIDS (PLWHA), irrespective of treatment status, but VL capacity was inadequate to cover needs in most reporting countries. Even when capacity was sufficient, machines were being underutilized; only 13.7% of existing CD4 capacity and only 36.5% of existing VL capacity were utilized across reporting countries in 2013.

Habiyambere and colleagues note that the responses were limited to national programs and did not include testing capacity in the private sector, and that incomplete responses or non-response to surveys limit the comprehensiveness of the survey data. However, they note that these findings identify shortfalls in VL testing capacity and underutilization of CD4 and VL technologies that will need to be addressed to reach the UNAIDS targets. They say: "With laboratory systems in reporting countries expanding, a national laboratory strategic plan to strengthen services must be developed, implemented, and monitored by governments and their national and international partners. The focus of international community, to ensure optimal use of laboratory technologies, should be on those countries where interventions for scaling up access to HIV diagnostic technologies are most needed."

In an accompanying Perspective, Peter Kilmarx and Ravia Simbi discuss the practical challenges of achieving high capacity and efficiency in all stages of HIV care and note that moving forward, "strong leadership, resources, planning, and management are needed to scale up laboratory services. Continuing monitoring efforts, like those of Habiyambere and colleagues, are essential."
-end-
Research Article

Funding:

The authors received no specific funding for this work that was done in the context of their regular work. However, VH has WHO activity funds to carry his technical work including this survey and data analysis in the context of his work in WHO and not specifically for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Habiyambere V, Ford N, Low-Beer D, Nkengasong J, Sands A, Pérez González M, et al. (2016) Availability and Use of HIV Monitoring and Early Infant Diagnosis Technologies in WHO Member States in 2011-2013: Analysis of Annual Surveys at the Facility Level. PLoS Med 13(8): e1002088. doi:10.1371/journal.pmed.1002088

Author Affiliations:

Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
GSSHealth, Baltimore, Maryland, United States of America

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002088

Contact:

Vincent Habiyambere

World Health Organization
Department of HIV/AIDS
20 Avenue Appia
Geneva, 1211
SWITZERLAND
+41227913945
habiyamberev@who.int

Perspective Article

Funding:

The authors received no specific funding for this work.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Kilmarx PH, Simbi R (2016) Progress and Challenges in Scaling Up Laboratory Monitoring of HIV Treatment. PLoS Med 13(8): e1002089. doi:10.1371/journal.pmed.1002089

Author Affiliations:

Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
Ministry of Health and Child Care, Harare, Zimbabwe

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002089

PLOS

Related Hiv Articles:

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.
The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.
Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.
NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
First ever living donor HIV-to-HIV kidney transplant
For the first time, a person living with HIV has donated a kidney to a transplant recipient also living with HIV.
The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.
Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.
HIV RNA expression inhibitors may restore immune function in HIV-infected individuals
Immune activation and inflammation persist in the majority of treated HIV-infected individuals and is associated with excess risk of mortality and morbidity.
HIV vaccine elicits antibodies in animals that neutralize dozens of HIV strains
An experimental vaccine regimen based on the structure of a vulnerable site on HIV elicited antibodies in mice, guinea pigs and monkeys that neutralize dozens of HIV strains from around the world.
State-of-the-art HIV drug could curb HIV transmission, improve survival in India
An HIV treatment regimen already widely used in North America and Europe would likely increase the life expectancy of people living with HIV in India by nearly three years and reduce the number of new HIV infections by 23 percent with minimal impact on the country's HIV/AIDS budget.
More Hiv News and Hiv Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#540 Specialize? Or Generalize?
Ever been called a "jack of all trades, master of none"? The world loves to elevate specialists, people who drill deep into a single topic. Those people are great. But there's a place for generalists too, argues David Epstein. Jacks of all trades are often more successful than specialists. And he's got science to back it up. We talk with Epstein about his latest book, "Range: Why Generalists Triumph in a Specialized World".
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.