New AIDSFree Resource: Viral Load and Early Infant Diagnosis Knowledge Base

AIDSFree has officially launched its newest web resource: the Viral Load (VL) and Early Infant Diagnosis (EID) Knowledge Base. Both VL testing and EID are essential to achieving 90-90-90 goals at country and global levels. The new resource, developed in consultation with clinicians and experts in logistics and lab management at USAID, serves as a one-stop resource for information on these critical interventions.

The knowledge base provides an up-to-date overview of the substantial evidence and experience base for VL testing and EID—covering global guidance and country experiences in areas such as laboratory management, logistics, clinical implementation, and monitoring and evaluation. It reflects the rapidly expanding number of innovative point-of-care (POC) and near-POC platforms developed to reduce costs, improve efficiency, and meet the needs of clinicians, supply chain managers, and lab technicians involved in VL testing and EID.

Innovations in POC and near-POC technology can enable more clinicians (including lower-level staff) to provide same-day results at the testing site, transforming the way HIV care and treatment are provided and enabling faster clinical decision-making. However, cost, regulatory requirements, and the time required to certify new devices all pose barriers to POC technology.

The knowledge base sheds light on two similar but distinct testing modalities. VL testing is vital for HIV treatment monitoring. By measuring the number of copies of the virus in the blood, clinicians are able to monitor the patient’s response to treatment allowing for earlier intervention through enhanced counseling for clients with adherence issues and, when necessary, earlier transition to appropriate second-line regimens in cases of treatment failure. EID is used for diagnosis of HIV among HIV-exposed infants, and facilitates earlier entry into care for HIV-positive infants.

Countries adopted these interventions quickly following the 2013 World Health Organization guidelines recommending their use. But many governments struggle to ensure widespread coverage. For both interventions, high-quality services depend on a complex array of supportive systems—including technical capacity in clinics and labs, demand creation, efficient sample transport, effective procurement processes, and consistent monitoring and evaluation. Inefficiency in any element negatively affects all other elements—and threatens the chances that providers and clients will get immediate results for VL testing or EID.

“Anything that creates a delay means delayed results, and that is a huge challenge,” says Aida Yemaneberhan. Delays require clients to return to the health center for results, possibly traveling long distance; and providers may not have other ways to contact the client about results. “This challenge is especially true for EID, where delays in receiving test results don’t just result in wasted materials and the time of clinicians, lab staff, and clients; but also in a loss or delay in getting HIV-positive infants into care and on treatment, leading to a possible loss to follow-up and high risk of morbidity or mortality.”

“It will take time before POC testing is universally available. And wherever you can’t do POC testing, then that sample transport network is going to be key,” Sabrina Eagan adds. “Wherever the samples are analyzed—at the district, facility, or central level—you must have a viable transport system available, and it should be coordinated for all the different types of laboratory testing, not standalone, parallel systems.”

The contents of AIDSFree’s Viral Load (VL) and Early Infant Diagnosis (EID) Knowledge Base—currently over 50 documents, tools, templates, articles, guidance documents, and presentations—showcase recent experiences with VL testing and EID implementation and scale-up, as well as information on procurement. The knowledge base will be updated regularly—users will be able to sign up for updates through a listserv on VL testing and EID and receive notifications for AIDSFree webinars presenting the latest findings on these topics. “People can also suggest updates and resources and tools to add,” Jennifer Pearson says. “And countries can use the materials to learn from each other’s experiences.”

Written by Aida Berhan, Jennifer Pearson, and Sabrina Eagan