ArticleAIDS (London, England)2011
Development and validation of systems for rational use of viral load testing in adults receiving first-line ART in sub-Saharan Africa.
Article in AIDS (London, England), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Longitudinal patients' cohorts for impactful research and HIV care at the Infectious Diseases Institute.African health sciences · 2022Article
- Interferon-γ-Inducible Protein 10 (IP-10) Kinetics after Antiretroviral Treatment Initiation in Ethiopian Adults with HIV.Microbiology spectrum · 2021Article
- Super learner analysis of real-time electronically monitored adherence to antiretroviral therapy under constrained optimization and comparison to non-differentiated care approaches for persons living with HIV in rural Uganda.Journal of the International AIDS Society · 2020Observational
- Clinical predictor score to identify patients at risk of poor viral load suppression at six months on antiretroviral therapy: results from a prospective cohort study in Johannesburg, South Africa.Clinical epidemiology · 2019Article
- A targeted approach for routine viral load monitoring in Malawian adults on antiretroviral therapy.Tropical medicine & international health : TM & IH · 2018Article
- Development of an algorithm for determination of the likelihood of virological failure in HIV-positive adults receiving antiretroviral therapy in decentralized care.Global health action · 2017Article
- HIV viral suppression in TREAT Asia HIV Observational Database enrolled adults on antiretroviral therapy at the Social Health Clinic, the National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia.Antiviral therapy · 2016Article
- Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy.HIV clinical trials · 2016Article
- Implementation and Operational Research: Risk Charts to Guide Targeted HIV-1 Viral Load Monitoring of ART: Development and Validation in Patients From Resource-Limited Settings.Journal of acquired immune deficiency syndromes (1999) · 2015Article
- Super Learner Analysis of Electronic Adherence Data Improves Viral Prediction and May Provide Strategies for Selective HIV RNA Monitoring.Journal of acquired immune deficiency syndromes (1999) · 2015Article
- Article
- CD4 criteria improves the sensitivity of a clinical algorithm developed to identify viral failure in HIV-positive patients on antiretroviral therapy.Journal of the International AIDS Society · 2014Article
- Optimal Allocation of Gold Standard Testing under Constrained Availability: Application to Assessment of HIV Treatment Failure.Journal of the American Statistical Association · 2013Article
- Combination implementation for HIV prevention: moving from clinical trial evidence to population-level effects.The Lancet. Infectious diseases · 2013Review
- Prediction of treatment failure using 2010 World Health Organization Guidelines is associated with high misclassification rates and drug resistance among HIV-infected Cambodian children.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2012Article
- Article
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9 authors.
Funding
Abstract
backgroundWorld Health Organization (WHO) immunological and clinical criteria for monitoring first-line antiretroviral treatment (ART) offer low accuracy for predicting viral failure. Targeting viral load assays to those at high risk has been recommended and a system to do this has been developed in Cambodia. Systems for use in sub-Saharan African populations were evaluated.
methodsA new Ugandan-based scoring system for targeting viral load assays was developed from data from the first 4 years of a Ugandan cohort (N = 559) receiving first-line ART. The accuracy of this, the Cambodian system and the WHO criteria to predict viral failure, through targeting viral load assays, were compared in a separate population of 496 Ugandans.
resultsThe new Ugandan scoring system included CD4 cell count, mean cell volume, adherence, and HIV-associated clinical events as predictors of viral failure. In the validation population, the Ugandan system undertook viral load assays in 61 (12.3%) cases offering 20.5% sensitivity and 100% positive predictive value (PPV) to predict viral failure. The Cambodian system undertook viral load assays in 33 (6.7%) cases producing 23.1% sensitivity and 90.0% PPV. WHO criteria recommended viral load assays in 72 (14.5%) cases offering 30.8% sensitivity and 100% PPV.
conclusionLocally developed algorithms based on clinical and immunological criteria may offer little additional accuracy over WHO criteria for targeting viral load assays. When possible, confirming viral load before switching therapy is recommended. Scoring systems are more flexible than WHO criteria in allowing ART providers to choose the proportion of the population that undergo targeted viral load testing.
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