Alemnji George, Onyebujoh Philip, Nkengasong John N
aDivision of Global HIV and Tuberculosis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia bState Department Office of the Global AIDS Coordinator and Health Diplomacy (S/GAC), Washington, D. C., USA cWorld Health Organization, Regional Office for Africa, Intercountry Support Team for East and Southern Africa, Harare, Zimbabwe.
Curr Opin HIV AIDS. 2017 Mar;12(2):165-170. doi: 10.1097/COH.0000000000000346.
Viral load measurement is a key indicator that determines patients' response to treatment and risk for disease progression. Efforts are ongoing in different countries to scale-up access to viral load testing to meet the Joint United Nations Programme on HIV and AIDS target of achieving 90% viral suppression among HIV-infected patients receiving antiretroviral therapy. However, the impact of these initiatives may be challenged by increased inefficiencies along the viral load testing spectrum. This will translate to increased costs and ineffectiveness of scale-up approaches. This review describes different parameters that could be addressed across the viral load testing spectrum aimed at improving efficiencies and utilizing test results for patient management.
Though progress is being made in some countries to scale-up viral load, many others still face numerous challenges that may affect scale-up efficiencies: weak demand creation, ineffective supply chain management systems; poor specimen referral systems; inadequate data and quality management systems; and weak laboratory-clinical interface leading to diminished uptake of test results.
In scaling up access to viral load testing, there should be a renewed focus to address efficiencies across the entire spectrum, including factors related to access, uptake, and impact of test results.
病毒载量检测是决定患者治疗反应和疾病进展风险的关键指标。不同国家正在努力扩大病毒载量检测的可及性，以实现联合国艾滋病规划署提出的在接受抗逆转录病毒治疗的艾滋病毒感染患者中实现90%病毒抑制的目标。然而，这些举措的影响可能会受到病毒载量检测各环节效率低下加剧的挑战。这将导致扩大检测规模的方法成本增加且效果不佳。本综述描述了病毒载量检测各环节可解决的不同参数，旨在提高效率并利用检测结果进行患者管理。
尽管一些国家在扩大病毒载量检测规模方面取得了进展，但许多其他国家仍面临众多可能影响扩大规模效率的挑战：需求激发不足、供应链管理系统无效；样本转诊系统不佳；数据和质量管理系统不完善；以及实验室与临床之间的联系薄弱，导致检测结果的利用率降低。
在扩大病毒载量检测的可及性时，应重新关注解决整个环节的效率问题，包括与检测可及性、利用率和检测结果影响相关的因素。
