Evidence map›Paper›PMID 32105625›Full record

Trial reportThe lancet. HIV2020

Point-of-care HIV viral load testing combined with task shifting to improve treatment outcomes (STREAM): findings from an open-label, non-inferiority, randomised controlled trial.

Paul K Drain, Jienchi Dorward, Lauren R Violette, Justice Quame-Amaglo, Katherine K Thomas, Natasha Samsunder, Hope Ngobese, Koleka Mlisana, Pravikrishnen Moodley, Deborah Donnell and 5 more

2 registry-linked trialsOpen access · greenAbstract readRandomized Controlled TrialEquivalence Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The lancet. HIV, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 80 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
80citing papers in PubMed, 6 pooled it
1.8field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03066128 nacompletednot on this map

Point-of-care Viral Load Testing to Enable Streamlined Care and Task Shifting for Chronic HIV Care

TypeinterventionalSponsorUniversity of WashingtonRan2017 to 2018Enrolled390ConditionsChronic HIV InfectionArmsPoint-of-care viral load testing, Lab-based viral load testing
NCT05048472 nacompletednot on this mapstarted 2022, after this paper: background citation

Implementation of Point of Care HIV Viral Load Monitoring to Improve Viral Load Suppression Among Children, Adolescents and Young People Living With HIV in East Africa

TypeinterventionalSponsorMRC/UVRI and LSHTM Uganda Research UnitRan2022 to 2025Enrolled956ConditionsHIV, Viral Load, Point of Care MonitoringArmsAbbott HIV-1/2 VL Point of care Device
3 · Its place in the literature

Who cites it

80 citing papers in PubMed, 6 syntheses or guidelines pooled it, 113 citations in OpenAlex.

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  4. A Review of Network Models for HIV Spread.Journal of acquired immune deficiency syndromes (1999) · 2025
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  12. Timeliness of Point-of-Care Viral Load Results Improves Human Immunodeficiency Virus Monitoring in Nigeria.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023
    Trial
  13. Clinical Outcomes in a Randomized Controlled Trial Comparing Point-of-Care With Standard Human Immunodeficiency Virus (HIV) Viral Load Monitoring in Nigeria.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023
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20 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 5 institutions in 3 countries.

Paul K DrainDepartment of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA. Electronic address: pkdrain@uw.edu.
Jienchi DorwardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.
Lauren R VioletteDepartment of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
Justice Quame-AmagloDepartment of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA.
Katherine K ThomasDepartment of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA.
Natasha SamsunderCentre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.
Hope NgobesePrince Cyril Zulu Communicable Disease Clinic, Durban Municipality, Durban, South Africa.
Koleka MlisanaSchool of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa; National Health Laboratory Service, Durban, South Africa.
Pravikrishnen MoodleySchool of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa; National Health Laboratory Service, Durban, South Africa; Department of Virology, Inkosi Albert Luthuli Central Hospital, Cato Manor, South Africa.
Deborah DonnellDepartment of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA.
Ruanne V BarnabasDepartment of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
Kogieleum NaidooCentre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, and Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Salim S Abdool KarimCentre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Department of Epidemiology, Columbia University, New York, NY, USA.
Connie CelumDepartment of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
Nigel GarrettCentre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
University of Washington · USCentre for the AIDS Programme of Research in South Africa · ZANational Health Laboratory Service · ZASouth African Medical Research Council · ZAUniversity of KwaZulu-Natal · ZA

Funding

University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI CONNIE L CELUM · 1988 to 2026
$104.9M
Point-of-care viral load testing to enable task shifting for chronic HIV careR21AI124719 · NIAID · UNIVERSITY OF WASHINGTON · PI DRAIN, PAUL K, GARRETT, NIGEL JOEL · 2016 to 2017
$336k
NIAID NIH HHS P30 AI027757NIAID NIH HHS R21 AI124719
6 · The paper itself

Abstract

backgroundMonitoring HIV treatment with laboratory testing introduces delays for providing appropriate care in resource-limited settings. The aim of our study was to determine whether point-of-care HIV viral load testing with task shifting changed treatment and care outcomes for adults on antiretroviral therapy (ART) when compared with standard laboratory viral load testing.

methodsWe did an open-label, non-inferiority, randomised controlled trial in a public clinic in Durban, South Africa. We enrolled HIV-positive adults (aged ≥18 years) who presented for their first routine HIV viral load test 6 months after ART initiation. Individuals were randomly assigned by a random number allocation sequence to receive either point-of-care viral load testing at enrolment and after 6 months with task shifting to enrolled nurses (intervention group), or laboratory viral load testing (standard-of-care group). The primary outcome was combined viral suppression (<200 copies per mL) and retention at 12 months after enrolment. A non-inferiority margin of 10% was used. Analysis was done by intention to treat. This study was registered with ClinicalTrials.gov, NCT03066128.

findingsBetween Feb 24, 2017, and Aug 23, 2017, we screened 657 participants, and 390 were enrolled and randomly assigned to either the intervention group (n=195) or standard-of-care group (n=195). 175 (90%) individuals in the intervention group and 148 (76%) individuals in the standard-of-care group had the primary outcome of retention with viral suppression, a difference of 13·9% (95% CI 6·4-21·2; p<0·00040). 182 participants (93%) in the intervention group had viral suppression compared with 162 (83%) in the standard-of-care group (difference 10·3%, 3·9-16·8; p=0·0025); 180 (92%) and 162 (85%) were retained in care (7·7%, 1·3-14·2; p=0·026). There were no adverse events related to point-of-care HIV viral load testing or task shifting.

interpretationPoint-of-care viral load testing combined with task shifting significantly improved viral suppression and retention in HIV care. Point-of-care testing can simplify treatment and improve outcomes for HIV-positive adults receiving ART in resource-limited settings.

fundingNational Institute of Allergy and Infectious Diseases.

Indexed as

AdultAnti-HIV AgentsDrug MonitoringFemaleHIV-1HIV InfectionsHumansMalePoint-of-Care TestingSouth AfricaTreatment OutcomeViral LoadAnti-HIV Agents

Identifiers

PMID32105625
PMCPMC7183312
OpenAlexW3006735625

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.