Point-of-Care HIV Load Testing Keeps Patients at Clinic

SEATTLE – Chances of keeping HIV patients in treatment with a suppressive viral load were enhanced when viral load testing was performed on the spot during clinic visits, researchers said here.

In a randomized non-inferiority trial comparing point-of-care testing to standard testing in a central laboratory (where turnaround averaged 2-3 days), rates of viral suppression and retention in care at 12 months – the composite primary endpoint – was achieved by 89.7% of patients assigned to point-of-care testing versus 75.6% of patients whose tests were done at the laboratory (P<0.01), said Paul Drain, MD, of the University of Washington here.

That difference met criteria for non-inferiority in the study, which was conducted in South Africa.

Retention in care, by itself, was also improved in the point-of-care testing group, by 7.7 percentage points (92.3% vs 84.6%, P=0.03). Viral suppression rates showed a similar increase: 10.3 percentage points, from 83.1% to 93.3% (P=0.003).

Drain explained at a press conference at the annual Conference on Retroviruses and Opportunistic Infections.

At the press conference, Drain said, “Point-of-care viral load testing significantly improved HIV viral suppression and retention in care in South Africa, partly by ensuring rapid receipt of viral load results to people living with HIV and their providers. Increasing access to point-of-care testing could help to achieve the 90-90-90 targets.”

Drain was alluding to the UNAIDS initiative that asks each country to achieve testing of 90% of people with HIV, bring 90% of those people identified with HIV into care, and then get 90% of the people in care to achieve HIV suppression to undetectable levels — and to accomplish all those feats by 2020.

“Point-of-care testing could have some benefit in the U.S. setting,” press conference moderator Susan Buchbinder, MD, of the University of California, San Francisco, told MedPage Today. “The issue is trying to catch your people early while they are with you who are not virus suppressed so you can do more interventions. More information is usually better and if there is a way to get them that information the better it would be. We are beginning to get point-of-care testing here for sexually transmitted infections. They are being rolled out in a variety of different settings.”

“Most people do real well in taking their medications and keeping [the] virus suppressed,” Drain said. “What point-of-care testing does is that it helps us identify the patients who are not doing well and we can attend to them immediately. Whether it is in South Africa or in Seattle once they leave the clinic – especially when you are talking about people who are having challenges with their therapy – it is very hard to reach them and get them back to the clinic.”

Worldwide, less than 50% of people on HIV therapy have achieved viral suppression, Drain said. “We felt that one of the reasons for the failure to achieve viral suppression is the long time to obtaining laboratory viral load results in clinical settings. Our objective in this randomized trial was to do point-of-care viral load testing to see if we could improve virus suppression.”

Drain and colleagues randomized 390 patients in the open-label study, assigning 195 to receive the point-of-care test. When results came back in 2-3 hours, clinicians reviewed them immediately with the patients.

“Almost everybody was willing to wait for their viral load results,” Drain said.

The other 195 patients had blood drawn and then were sent home. Results were shared at patients’ next clinic visit. “While it takes about 2-3 days for the laboratory to turn around these tests,” Drain told MedPage Today, “practically it means that the patient doesn’t learn of his viral load level for a median of 28 days.”

When it was time to evaluate the patients, 189 of the 195 in the point-of-care testing group had their viral load results; 178 of the standard of care cohort had their viral load results.

Study participants averaged about age 31 years, and 60% were women; more than 20% of the patients had to travel more than 5 kilometers to reach the clinic. About one-third of the patients had been diagnosed with HIV infection for more than a year.

Drain said the point-of-care testing in the South African clinics cost about $22, slightly lower than the $25 for laboratory analysis. He noted that the costs were subsidized by the South African government.