It is the standard of care in wealthy countries, a means of tracking the effectiveness of and adherence to drug regimens before failure causes illness, and it is the measurement of the most critical goal of HIV treatment — protecting health and lowering transmission risks by making the virus undetectable.
And yet, in resource poor countries where the value of regular viral load testing would be greatest — to prevent illness as well as misdiagnosed resistance that leads to unnecessary switches to drugs, to ensure that treatment for HIV also prevents transmission of the virus, and to show whether efforts are successful — it is also hardest to find.
The value of viral load testing was recognized in 2003 with World Health Organization guidelines urging the development of cost effective measures to make the testing more readily available. It has been documented in studies and reports since, including in Medecins Sans Frontieres Access Campaign’s Undetectable report last year. The reason viral load testing is not routine where needed most is even more familiar than the arguments for its use — it is too expensive and too hard to use. At the same time, the cost of not measuring viral load is higher; MSF’s data showed that when patients on ART were tested, only 30 percent of those whose treatment appeared to be failing had elevated viral loads. Testing, the data implied, kept 70 percent of the patients from being switched to more expensive medicine that they did not need. In December, MSF, which examined potential ways to increase access to viral load testing in its previous report, released How Low Can We Go? a preliminary brief exploring ways to reduce the costs of viral load testing. The organization will release a full report on findings from six countries later this year. In the meantime, the brief shows a wide variation in costs for the tests that indicates prices could drop steeply and immediately through negotiation and that countries could adopt improved efficiencies, including task shifting, pooling tests, using existing networks to deliver samples and results from testing. The briefing says price transparency, donor support in implementing needed changes, lower costs for licensing technologies used in tests for sale in countries where prices put tests out of reach, and making the most of high volume bargaining power should be immediate aims to increase viral load testing access.