Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Field performance and cost-effectiveness of a point-of-care triage test for HIV virological failure in Southern Africa
Journal of the International AIDS Society, Volume 26, No. 10, Article e26176, Year 2023
Notification
URL copied to clipboard!
Description
Introduction: Antiretroviral therapy (ART) monitoring using viral load (VL) testing is challenging in high-burden, limited-resources settings. Chemokine IP-10 (interferon gamma-induced protein 10) strongly correlates with human immunodeficiency virus (HIV) VL. Its determination could serve to predict virological failure (VF) and to triage patients requiring VL testing. We assessed the field performance of a semi-quantitative IP-10 lateral flow assay (LFA) for VF screening in South Africa, and the cost-effectiveness of its implementation in Mozambique. Methods: A cross-sectional study was conducted between June and December 2021 in three primary health clinics in the Western Cape. Finger prick capillary blood was collected from adults on ART for ≥1 year for direct application onto the IP-10 LFA (index test) and compared with a plasma VL result ≤1 month prior (reference test). We estimated the area under the receiver operating characteristic curves (AUC), sensitivity and specificity, to evaluate IP-10 LFA prediction of VF (VL>1000 copies/ml). A decision tree model was used to investigate the cost-effectiveness of integrating IP-10 LFA combined with VL testing into the current Mozambican ART monitoring strategy. Averted disability-adjusted life years (DALYs) and HIV acquisitions, and incremental cost-effectiveness ratios were estimated. Results: Among 209 participants (median age 38 years and 84% female), 18% had VF. Median IP-10 LFA values were higher among individuals with VF compared to those without (24.0 vs. 14.6; p<0.001). The IP-10 LFA predicted VF with an AUC = 0.76 (95% confidence interval (CI) 0.67–0.85), 91.9% sensitivity (95% CI 78.1–98.3) and 35.1% specificity (95% CI 28.0–42.7). Integrating the IP-10 LFA in a setting with 20% VF prevalence and 61% VL testing coverage could save 13.0% of costs and avert 14.9% of DALYs and 55.7% new HIV acquisitions. Furthermore, its introduction was estimated to reduce the total number of routine VL tests required for ART monitoring by up to 68%. Conclusions: The IP-10 LFA is an effective VF triage test for routine ART monitoring. Combining a highly sensitive, low-cost IP-10 LFA-based screening with targeted VL confirmatory testing could result in significant healthcare quality improvements and cost savings in settings with limited access to VL testing. © 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.
Authors & Co-Authors
Saura-Lázaro, Anna
Spain, Barcelona
Universitat de Barcelona
Bock, Peter
South Africa, Stellenbosch
Stellenbosch University
Granés, Laura
Spain, Barcelona
Hospital Clinic Barcelona
Nel, Kerry
South Africa, Stellenbosch
Stellenbosch University
Naidoo, Vikesh
South Africa, Stellenbosch
Stellenbosch University
Scheepers, Michelle
South Africa, Stellenbosch
Stellenbosch University
Ramponi, Francesco
Spain, Barcelona
Universitat de Barcelona
Paulussen, René
Netherlands, Amsterdam
Mondial Diagnostics
Rinke de Wit, Tobias Floris
Netherlands, Amsterdam
Amsterdam Institute for Global Health and Development
Netherlands, Amsterdam
Universiteit Van Amsterdam
Naniche, Denise
Spain, Barcelona
Universitat de Barcelona
Lopez Varela, E.
Spain, Barcelona
Universitat de Barcelona
Statistics
Authors: 11
Affiliations: 6
Identifiers
Doi:
10.1002/jia2.26176
ISSN:
17582652
Research Areas
Disability
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Mozambique
South Africa
Participants Gender
Female