Jointly led by IRD and INSERM, this research explores access to viral load testing for HIV patients in decentralized areas.
Fabien Taieb, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2018 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
Access to viral load testing for HIV-infected patients in resource-limited countries is a major public health issue that deserves special attention. Indeed, despite significant advances in antiretroviral treatment (ART), many patients find themselves in a situation where they do not receive adequate follow-up. This compromises not only their individual health but also that of their communities, thereby exacerbating the spread of the virus. Fabien Taieb's thesis highlights the obstacles faced by these patients, including the distance from laboratories capable of performing viral load tests, as well as the lack of human and material resources.
In many West African countries, such as Benin, health infrastructures are often insufficient. Patients must travel long distances to access equipped health centers, which can discourage those living in rural or isolated areas. For example, a patient living 100 kilometers from a laboratory may be deterred from attending regular consultations, leading to a break in the follow-up of their treatment.
Dried Blood Spots (DBS) appear as a promising solution to overcome these challenges. Their use simplifies the sampling process, avoids cold chain constraints, and utilizes equipment already available in health centers. Indeed, DBS can be easily collected by trained health workers, even in remote areas. Research results show a sensitivity of 93.3% and a specificity of 94.8% for measuring viral load from DBS. This paves the way for integrating this method into virological monitoring strategies, making the process more accessible for patients.
However, implementing this solution requires strong political will and investments in health infrastructures. Decision-makers must consider the importance of access to viral load testing to improve patient retention and reduce rates of therapeutic failure. Data collected in Cameroon and Vietnam underscore the urgency to act: a retention rate of 39.9% at 36 months and a viral suppression rate of 59.8% are alarming. These figures reveal not only gaps in patient follow-up but also a missed opportunity to control the HIV epidemic.
It is imperative to act to ensure that all patients have access to adequate virological monitoring. Health policies must evolve to integrate DBS as a standard tool in monitoring patients on ART. This also requires ongoing training for health personnel so that they can explain to patients the importance of these tests and encourage them to undergo regular follow-up.
Ultimately, it is about saving lives and preventing the spread of HIV in the most vulnerable communities. Governments must also commit to raising awareness among populations about the importance of screening and treatment by implementing information campaigns tailored to local realities. Furthermore, partnerships with non-governmental organizations and community actors can strengthen these efforts by facilitating access to care and breaking the taboos surrounding HIV.
In summary, the integration of DBS into the health systems of resource-limited countries represents a significant advancement. This could transform the landscape of virological monitoring and offer a glimmer of hope to millions of patients living with HIV. The stakes are clear: it is time to act, mobilize the necessary resources, and make access to viral load testing a fundamental right for all.
Key Facts
- 65.4% : Viral success rate at 12 months of ART according to a meta-analysis.
- 39.9% : Patient retention rate in Cameroon at 36 months.
- 59.8% : Viral suppression rate in Cameroon.
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Sources and Access
Fabien Taieb. Accès à la charge virale pour les patients infectés par le VIH sous traitement antiretroviral, en zone décentralisée des pays à niveau de ressources faible ou modéré. Médecine humaine et pathologie. Université Montpellier, 2018. Français. ⟨NNT : 2018MONTT041⟩. ⟨tel-01972063⟩