AFRICA: Cheaper HIV/AIDS monitoring tools needed

Poorer countries need faster and cheaper HIV/AIDS monitoring techniques, as most tests used for managing the virus are out of their reach, according to a new report.

African physicians attending a recent meeting on "Monitoring and Diagnostic Tools for the Management of Antiretroviral Therapy in Resource-Poor Settings", called for a "no-tech" minimum standard for diagnostic and treatment evaluation that lays out basic criteria for clinical testing.

According to a report in the American Foundation for AIDS Research (AMFAR) Treatment newsletter, viral load tests cost an average of US $100, excluding laboratory equipment. The plasma viral load is a measure of HIV replication and the suppression of viral replication is one of the primary goals of antiretroviral therapy.

The cheapest equipment for measuring CD4 counts cost $75,000 to $100,000, and added to this expense is money needed to train and hire technical staff, maintain and repair broken equipment and ship and store samples, the report added.

Existing guidelines for managing patients on antiretroviral therapy (ART) use viral load and CD4 count testing to measure the impact of ART on the patient's health.

"There's no question about our ability to afford it: we just can't. We need alternatives and, unfortunately, we need them soon," Serge Diagbouga, an HIV doctor at the Centre Muraz in Burkina Faso, was quoted as saying in the report.

Researchers at the conference, however, proposed the use of "syndromic" management of HIV/AIDS - a simpler approach, which relies on physical symptoms rather than laboratory values - to gauge the impact of therapy on the patient's disease status.

Dr Mark Cotton of the Tygerberg Children's Hospital in Cape Town, told PlusNews on Monday that this method would be "exceptionally appropriate in rural areas and areas where they can't afford the equipment". He warned, however, that despite research conducted about syndromic management, the approach had not yet been validated.

Monitoring equipment to test viral loads was available at the Cape Town hospital but was not used often as it was too expensive, said Cotton. "Essentially we could treat a patient for almost a month for the cost of a viral load test," he added.

According to Cotton, viral load testing was a "waste of time" as it decreased the amount of time spent on therapy. The tests could be used in a limited way, if they were cheaper, he said.

A major obstacle in South African hospitals is that there are no antiretroviral (ARV) drugs as the government's policy has been to refuse the introduction of ARV therapy in state hospitals. "Well, the first thing we would need before doing any monitoring, are the drugs," said Cotton.

CD4 testing equipment was available without charge at the hospital and this was enough for reasonable clinical monitoring, he said. WHO guidelines for implementing antiretroviral therapy in resource-limited settings indicate that where viral load tests are not available, measuring a rise in the CD4 count "is an acceptable indication of treatment efficacy".

For more information:
http://www.amfar.org/cgi-bin/iowa/td/feature/record.html?record=53

Theme (s): Care/Treatment - PlusNews,

[This report does not necessarily reflect the views of the United Nations]