Major improvements in HIV laboratory capacity utilization are needed in low- and middle-income countries if the global UNAIDS 90-90-90 targets for HIV and AIDS diagnosis and treatment are to be met, according to a World Health Organization study.
The study, based on 3 years of WHO survey data from 127 countries (not including the United States), says achieving the 90-90-90 targets depends heavily on improved access to high-quality testing for early infant diagnosis and treatment monitoring. The availability of “cluster of differentiation 4” (CD4) and viral load testing instruments currently meets the needs of individuals living with HIV/AIDS, but the tests are not being utilized to their full potential.
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“Expanding access to treatment requires high-quality HIV testing technologies, including CD4 to assess risk of disease progression, viral load testing to monitor treatment efficacy, early infant diagnosis to determine HIV-infection status in HIV-exposed children, and other monitoring capabilities within a tiered laboratory network,” wrote Vincent Habiyambere, MD, of the WHO in Geneva and his colleagues in a study published online Aug. 23 in PLOS Medicine.
Overall, 13.7% of existing CD4 testing capacity and 36.5% of existing viral load capacity were used in 2013. In addition, 7.4% of existing CD4 instruments and 10% of viral load instruments were not in use by the end of 2013 because of several factors including lack of reagents, improperly installed or destroyed equipment, and lack of staff training.
The survey results were limited by underreporting in some programs and the collection of data from the public sector only, the researchers noted. But the data suggest that “regardless of the need for point of care, it is clear that laboratory-based monitoring will remain a key component of HIV programmes now and in the future,” the authors said. “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 international partners.”
Read the full study in PLOS Medicine (doi:10.1371/journal.pmed.1002088).