[Ip-health] MSF calls for scale-up of ‘viral load’ monitoring to improve HIV treatment outcomes in developing countries

Joanna Keenan-Siciliano joanna.l.keenan at gmail.com
Tue Dec 10 08:21:07 PST 2013

*MSF calls for scale-up of ‘viral load’ monitoring to improve HIV treatment
outcomes in developing countries*


*Global Fund and US-government PEPFAR programme must use purchasing power
to get better prices for viral load tests*

*Cape Town,10 December 2013*—The international medical humanitarian
organisation Médecins Sans Frontières (MSF) is calling for increased
scale-up of ‘viral load’ HIV treatment monitoring  in order to help improve
people’s HIV treatment outcomes. At the ICASA HIV/AIDS conference in Cape
Town, South Africa, MSF reported on new findings on the benefits of viral
load monitoring for people on antiretroviral therapy and strategies to
reduce the costs. The Global Fund to Fight AIDS, Tuberculosis, and Malaria
and the United States’ PEPFAR programme—the two main funders of global HIV
treatment—need to act now and use their large purchasing power to negotiate
drastically lower prices for viral load tests.

“The benefits of implementing viral load testing are really obvious—it's
the gold standard for treatment monitoring, but it’s largely unavailable in
developing countries because cost is a major factor,” said Dr. Gilles van
Cutsem, Medical Coordinator of MSF in South Africa. “Prices need to come
down so that countries can scale up, and new research shows this is

A 2012 MSF survey of 23 resource-limited countries showed that while
virtually all countries included viral load monitoring in their treatment
guidelines, it was available in only four. The latest World Health
Organization HIV treatment guidelines call for people to receive a viral
load test once a year to ensure their treatment is working, and to identify
those people who are either failing treatment, and must be switched to
different drugs, or need extra adherence support to get back on track.
Viral load is much more accurate at detecting problems than CD4 testing,
which is commonly used today, and it can also prevent people from being
unnecessarily switched to more expensive ‘second-line’ medicines. Ideally,
viral load testing confirms the level of HIV in a person’s blood is
‘undetectable,’ which means antiretroviral medicines have suppressed the
virus maximally. This is the best for their own health and also for their
communities, as undetectable HIV is very unlikely to be transmitted to

An MSF study being presented at the ICASA conference looked at the
first-ever viral load test among adults on ART in three African countries
starting to implement viral load (Kenya, Malawi, and Zimbabwe).  MSF found
that among people who were suspected of failing their treatment based on
clinical signs or immunological criteria (CD4 testing) alone, only 30%
actually had an elevated viral load, indicating a problem. This means that
70% of people could have been switched unnecessarily to second-line
treatment if viral load had not subsequently been used to confirm treatment

Additional research showed that costs of viral load tests can come down
much further.

MSF research shows that the cost of reagents and consumables—materials
needed to run each viral load test—accounts for up to 75% of the full cost
of running a viral load test (which includes machines, transport, human
resources, etc.) Prices paid for the reagents and consumables range widely
among several African countries with a high burden of HIV, from US$11 - $55
per test. PEPFAR and the Global Fund should pool their procurement, thereby
making use of projected large volumes to proactively negotiate lower prices
with companies. Additional data shows that the estimated cost of
manufacturing reagents and consumables is as low as $1.61 - $4.50 for the
three most commonly used tests used in Africa, supplied by Roche, Abbott
and bioMérieux. Taking into account the real cost of reagents and
consumables, with pooled procurement, the price of reagents and consumables
could be as low as $7 or less per test.

“If we want to close the gap between rich and poor countries when it comes
to making sure people’s HIV treatment is working, we need to see the price
of viral load testing come down fast,” said Sharonann Lynch, HIV Policy
Advisor for MSF’s Access Campaign. “The big   agencies paying for global
HIV treatment—the Global Fund and PEPFAR—need to wake up and see the
potential they have to push viral load test prices down and into the reach
of countries affected by the epidemic.”

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