Patients with an undectable viral load are less likely to pass the infection onto others but the “golden standard” in HIV treatment monitoring may be out of reach for many

Sipho Ngcobo lives in Lusikisiki in rural Eastern Cape. Although he has been on ARVs for only two years, Ngcobo feared he had become resistant to his ARVs earlier this year after he started losing weight.

“I started feeling weak and losing weight and thought maybe my viral load had gone up,” he told Health-e News.

Ngcobo hoped that his annual HIV viral load test at Lusikisiki’s St Elizabeth Gateway Clinic would help doctors to uncover what was behind his weight loss. But Ngcobo alleges he was turned away multiple times by clinic staff without having his viral load done.

Viral load testing measures the amount of HIV in a person’s blood and is the best way for health workers to see if patients are responding to ARV treatment or if they have developed resistance and need to be changed to other ARVs.

The less HIV in a person’s blood, the less likely they are to pass the virus onto others.

According to national guidelines, newly initiated ARV patients should receive a viral load test after three months.

Following that, most ARV patients should receive viral load testing every six months unless previous tests have shown very low viral loads, according to Southern African HIV Clinicians Society President Dr Francesca Conradie.

Once patients have achieved a very low viral load count, often called “undetectable,” they may only need to be tested annually, Conradie added.

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“I tried many times to get clarity as to why I was not getting my viral load, since it was over a year that I did the last test,” said Ncgobo. “The only answer I was given is that the nurses are under-staffed, and I must come back another time.”[quote float=”right”]”It’s very important that the Department of Health starts doing a better job of collating and publicly reporting data”

 Portia Serote, TAC’s National Women’s Sector Representative, says that many HIV patients are not getting important viral load tests or results.

“There are patients whose viral load results might be high,” Serote told Health-e News. “Instead of (nurses) doing another viral load at six months to check the progress of a patient, (patients) will have to wait another year for another test.”

“What we are seeing is nurses themselves are not understanding the purpose of a viral load test and are not being able to explain it to patients,” said Serote, who added that test result delays might keep patients on drugs to which they are resistant to for longer.

“This has a major impact on patients who are resistant to treatment as they have to wait longer to be switched to another regimen,” she added.

No one knows how many received viral load tests in 2014

In 2013, the National Department of Health released figures that showed less than half of ARV patients had received a viral load test within nine years.

Wendy Stevens, head of the National Health Laboratory Services’ (NHLS) National Priority Programmes Unit, recently disputed this figure and reported that the NHLS had processed 2.7 million viral load tests in 2014.[quote float=”right”]”With the implementation of patient unique identifiers, we could have more accurate data”

But the NHLS Viral Load Unit’s Dr Sergio Carmona said that, without unique patient identifiers, it is difficult to know just how many people received viral loads in 2014. However, using assumptions based on current guidelines, Carmona estimated that this may mean that about 2 million* ARV patients had viral load tests in 2014.

“We hope that soon, with the implementation of patient unique identifiers, we could have more accurate data,” said Carmona, who added that viral load testing in the country is hampered by a lack of skilled healthcare workers able to collect blood samples and staff shortages.

A unique patient identifier is a code assigned to patients that allows them to be tracked within the health system. Government approved the introduction of such a number a year ago.

TAC Head of Policy Marcus Low said conflicting data from the Department of Health and NHLS is a problem.

“It’s very important that the Department of Health starts doing a better job of collating and publicly reporting data on viral load coverage and viral suppression rates, ” said Low, who encouraged all ARV patients to demand a viral load test annually.

“If people are not getting their annual viral load test, then they are receiving sub-standard care,” he added. “There is no excuse for this.” – Health-e News.

Additional reporting by Mtshana Mvilisi

• Read more: Western Cape integrates viral load testing into new PMTCT guidelines

 

*The story originally said “20 million” ARV patients had received viral loads, according to Camona. This should have read 2 million and the story was corrected on 10 December to reflect this.