There are more than 36 million people living with HIV globally, with 7.9 million in South Africa. To achieve Sustainable Development Goal 3.3 "to eliminate AIDS by 2030", the World Health Organization recommends life-saving antiretroviral therapy (ART) for all people with HIV. This stops the HIV virus from damaging the immune system, meaning people can have long and healthy lives, and that they won’t pass HIV on to their sexual partners.
People taking ARVs should have regular viral load blood tests to measure how much virus is in their blood. If someone’s viral load is high, they may be having difficulty taking their treatment, or their treatment may not be working because the HIV has become resistant. Healthcare workers can then counsel and support people in taking their treatment, or change their ARVs. Viral load testing is complex and normally performed in specialist laboratories. However, in Africa (including South Africa), most HIV treatment is provided in community clinics which don’t have good access to laboratory viral load testing. This means that many people who are struggling to take their treatment, or who have drug resistant HIV, are not identified and managed well.
In the POwER study, we are researching whether new point-of-care viral load tests can be used in community clinics to provide results on the same day, so that people with a high viral load have immediate care. This work could lead to important improvements in HIV care in South Africa and around the world, by helping to make viral load testing more accessible, and by improving support and treatment for people with high viral loads. Altogether, this could help people with HIV to take their treatment, avoid HIV drug resistance, prevent new HIV infections and live longer, healthier lives.
POwER is a collaboration between the Centre for the AIDS Programme of Research in South Africa (CAPRISA) at the University of KwaZulu-Natal, the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and the eThekwini Municipality Health Unit in Durban, South Africa.
This feasibility study will be completed in 2021. To date, we have enrolled 66 participants, introduced two new point-of-care HIV viral load tests, and a novel urine drug level ART adherence assay, which we are evaluating in the study. We plan to train nurses to use these assays in 2021, and through this and the completed study, to develop a point of care intervention that can be used by nurses to improve monitoring of HIV in South African clinics and other DAC settings.
This project was funded by the University's GCRF QR fund.