Mumbai: The international medical humanitarian organisation Doctors Without Borders/Medecins Sans Frontieres (MSF) has been working hand-in-hand with the Mumbai Districts AIDS Control Society (MDACS) and Municipal Corporation of Greater Mumbai (MCGM) since 2016 to support the implementation of routine viral load testing and systematic screening of TB for People Living with HIV (PLHIV).
According to World Health Organisation (WHO), a patient is considered stable on Anti-Retroviral Therapy (ART) based on the following criteria: on ART for at least 1 year, no current illnesses, good understanding of lifelong adherence and evidence of treatment success (two consecutive viral load measurements below 1,000 copies/ml). Routine Viral Load Testing (RVTL) is a key recommendation of WHO’s 2016 consolidated guidelines on the use of ART which recommends RVTL to be conducted at 6 and 12 months post initiation of ART and every year thereafter.
A year later, the initiative in Mumbai has shown remarkable results and provides evidence that routine viral load testing for treatment monitoring along with Enhanced Adherence Counseling (EAC) is feasible and effective in a high burden public setting. In many patients, it resulted in an earlier switch to second line anti-retroviral therapy while also preventing an unnecessary switch in treatment regimens.
As part of this collaboration, till the end of October 2017 over 3,507 PLHIVs underwent viral testing at the ART centre in King Edward Memorial (KEM) hospital. Of these, over 3,270 (93.3%) were referred for routine monitoring and 237 (7.7%) for suspected treatment failure from the District AIDS Clinical Expert Panel (DACEP). Of the total 3,507 tested for VL, 90% had viral load suppressed (VL value < 1000 copies/ml). Among those tested for routine monitoring (3,270 PLHIV), 3,018 (93.3%) had viral load suppressed. 252 PLHIV, who had high viral load were subjected to EAC and followed by conducting a repeat viral load. Due to EAC, viral became suppressed among 25% PLHIV. Remaining 75% PLHIV were referred to the district clinical expert panel for treatment switch.
“In the program setting, 90% PLHIV with suppressed viral load is a very good result. The result shows that, as and when the routine viral load is made available in the program, UNAIDS’s third target of 90% of people in treatment with fully suppressed viral load is achievable. Considering the benefit of Enhanced Adherence Counseling, MDACS has adopted and implemented the tool for all ART centres across Mumbai. ” said Dr Srikala Acharya, Additional Project Director of MDACS
“This initiative has shown us that increased access to routine viral load monitoring is the key for better treatment monitoring for PLHIV. It is also critical in identifying PLHIV who are having trouble with adherence in time and who would benefit from receiving enhanced adherence counselling. It also helps identify those who are taking their drugs but no longer benefiting from it because of resistance. We hope that this initiative would be further scaled up in Mumbai district and rest of the country, to demonstrate nationally the importance of access to routine viral load monitoring,” said Dr Naresh Gill, MSF.
As part of this initiative, MSF had contributed to the lab capacity of KEM hospital by installing a GeneXpert machine which can run 64 samples every day. MSF has also supported MDACS in formulating EAC guidelines which were later adopted across all ART centres in Mumbai district; apart from supporting with trainings and health promotion activities among PLHIVs.
For more information,
Siddhesh Gunandekar, Advocacy and Communication Manager, MSF
Email id: firstname.lastname@example.org
Notes to Editor
MSF in India:
MSF is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters and exclusion from healthcare in around 70 countries. MSF offers assistance to people based only on need and irrespective of race, religion, gender or political affiliation. MSF has been working in India since 1999, providing free-of-charge essential healthcare in the states of Andhra Pradesh, Bihar, Chhattisgarh, Delhi, Jammu & Kashmir, Jharkhand, Maharashtra, Manipur, Telangana, Uttar Pradesh, and West Bengal. MSF received the Indira Gandhi Prize for Peace, Disarmament and Development in 1996 and the Nobel Peace Prize in 1999.
More information on Mumbai project can be found here: https://www.msfindia.in/providing-medical-care-dr-tb-hiv-and-hepatitis-mumbai