Insight

Viral load testing: the key to tackling the HIV epidemic

by Laura Mundy

Viral load testing is a critical component of HIV care. However, more than 40% of people living with HIV do not have access to regular viral load tests.

In June 2018, MedAccess, the Clinton Health Access Initiative and Hologic, a medical technology company, launched the Global Access Initiative. The Initiative seeks to increase access to viral load testing for people living in underserved communities through Hologic’s Panther platform.

Ahead of World AIDS Day 2020, we spoke with two laboratory technicians, in Kenya and Zambia, about their experiences using Panther and the impact it has had on their work and the lives of patients.

The HIV viral load challenge

There is no cure for HIV. Living with HIV means a lifetime of adherence to antiretroviral (ARV) treatment. The treatment is designed to reduce a person’s viral load – the amount of HIV in their body – with the aim of reducing it to an undetectable amount. If a person’s viral load is undetectable, they can expect a near-normal lifespan and, crucially, they cannot pass HIV to anyone else.

Knowing your viral load is the sticking point. With 1.7 million new HIV diagnoses every year around the world, and 37.9 million people already living with HIV, testing and monitoring every person’s viral load is a major challenge.

In Kenya, for example, 1.6 million people are living with HIV. Everyone who is diagnosed is put on treatment straight away and must have a viral load test after six months to check that the treatment is working. Once a person’s viral load is classed as undetectable, they only need to have a test once a year.

But add to this: pregnant women who should be tested every three months and babies born to HIV-positive mothers who require immediate testing – and the number of tests needed exceeds two million per year.

Seizing the initiative

That’s why we joined the Global Access Initiative in 2018, providing a volume guarantee to Hologic. Through the guarantee, Hologic is able to offer HIV viral load testing at a lower price in up to 49 countries, mostly in Asia and sub-Saharan Africa.

Their Panther testing platform has the capability to perform viral load tests simultaneously for HIV and hepatitis and to perform diagnostic tests for human papillomavirus. It has also been approved for COVID-19 diagnostic testing. In countries with high rates of HIV, viral hepatitis, and HPV infections, this functionality can reduce the time patients wait for test results and lead to improved care.

Scientists and laboratory managers like Erick Ochieng from Kenya and Chisanga Chileshe from Zambia now have Hologic Panther instruments in their laboratories, enabling them to process far more viral load tests than they could before.

“It’s different from anything else I’ve ever used.”

Erick Ochieng is a Research Scientist at the KEMRI Nairobi Laboratory in Kenya. He is one of four colleagues at the laboratory who use the Hologic Panther platform to conduct HIV viral load testing.

“There has been a remarkable difference since we got the Panther”, he says. “The flexibility is unparalleled. Because the Panther testing machine is fully automated, this allows us to load samples for testing randomly, meaning we can load a sample at any given time that the equipment is on.”

The random access capability means that Eric can load samples as he receives them, rather than having to wait to run tests in batches. “I’m no longer working in batches of 20 and waiting five hours for them to finish before I can load another batch”, he explains.

“The Panther can be left on to run twenty-four hours a day. With no machine downtime, it can conduct 1,000 tests a day, doubling the testing capacity of our last machine. Priority samples can be added in straight away, rather than waiting for a new batch like we used to. A sample can render a result within two hours rather than five.”

“Patients can get results in three days, not three weeks.”

Chisanga Chileshe is a Laboratory Manager at the University of Zambia Teaching Hospital. Thanks to the Panther machine, her lab can provide health care professionals and patients with faster access to accurate HIV viral load results.

“With the older machines, patients would have to wait three weeks for their results. Now they get results in three days,” she says.

“The Panther machine allows us to conduct viral load testing to detect adherence issues in people living with HIV.

“When someone has a high viral load, they are offered advanced adherence counselling. The fact that we can provide someone with their viral load results within three days means that they can start counselling straight away. Three weeks later they will have another viral load test to determine the effectiveness of the counselling. If they do not show reduced viral load, we conduct drug resistance testing. This means we can change their drug regimen so much sooner than before,” explains Chisanga.

With lab technicians and scientists able to render results quickly, clinicians can make informed decisions about a patient’s treatment in a much shorter timescale.

In 2019 alone, an estimated 182,000 people in seven African countries benefitted from improved clinical outcomes as a result of our guarantee for Hologic. We look forward to continuing our partnership and helping people living with HIV to live longer, healthier lives.

MedAccess launched a volume guarantee with Hologic – a global healthcare and diagnostics company – in July 2018 as part of the Global Access Initiative, to reduce viral load testing price for HIV and hepatitis and the diagnostic test price for HPV, improve patient access to high-quality viral load tests, and shift the market towards all-inclusive output-based procurement. Under the terms of the guarantee, Hologic agreed to offer the Panther platform to countries at an all-inclusive ceiling price of $12 per patient test.