Near point-of-care HIV viral load testing: Uptake and utilization in suburban Yangon, Myanmar

Abstract

AbstractIntroductionHIV viral load testing in resource-limited settings is often centralized, limiting access. Near point-of-care (POC) viral load testing was introduced in Myanmar in 2017. We assessed its uptake and utilization.MethodsRoutine program data from three HIV clinics of Medical Action Myanmar were used. Annual viral load uptake was cross-sectionally analysed in people living with HIV (PLHIV) on antiretroviral therapy (ART) initiated between July 2009-June 2019. Attrition at two years was assessed between PLHIV with different access to viral load testing with Kaplan-Meier analysis. For those eligible for a first viral load when near POC viral load became available, a viral load cascade was constructed. We used logistic regression to explore predictors of confirmed virological failure after a first high viral load.ResultsAmong 5271 PLHIV who started ART between July 2009-December 2019, annual viral load uptake increased significantly after near POC was introduced. Attrition in the first two years after ART initiation was not different among those eligible for a first viral load before viral load was available, after centralized laboratory-based viral load, and after near POC viral load introduction. After introduction of near POC viral load, 92% (2945/3205) of eligible PLHIV received a first viral load, a median of 2.8 years (IQR: 1.4-4.4) after initiation. The delay was 3.7 years (IQR: 2.8-5.1) and 0.9 years (IQR: 0.6-1.4) in those becoming eligible before and after near POC viral load was available, respectively. Among those with a first viral load, 95% (2796/2945) were ≤1000 copies/ml. Eighty-four % (125/149) of those with a viral load >1000 copies/ml received enhanced adherence counselling and a follow up viral load, a median of 119 days (IQR: 95-167) after the first viral load. Virological failure was confirmed in 67% (84/125), and 82% (69/84) of them were switched to second-line ART. Nine-three % (64/69) among those switched were alive on ART at end of follow-up. Having a first viral load of ≥5000 copies/ml was associated with confirmed virological failure.ConclusionNear POC viral load testing enabled rapid scale-up of viral load testing in Myanmar. PLHIV with a high viral load were adequately managed.