HIV viral load monitoring among key populations in low- and middle-income countries: Challenges and opportunities: Challenges

Sheree Schwartz, Matthew M. Kavanagh, Jeremy Sugarman, Sunil Solomon, Illiassou M. Njindam, Kevin Rebe, Thomas C Quinn, Coumba Toure-Kane, Christopher Beyrer, Stefan Baral

Research output: Contribution to journalArticle

Abstract

Introduction: Key populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population-level, community viral load is a metric of HIV programme effectiveness and can identify "hotspots" of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations. Discussion: Viral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes. Conclusions: Opportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalJournal of the International AIDS Society
Volume20
DOIs
StatePublished - Nov 1 2017

Fingerprint

Viral Load
HIV
Population
Program Evaluation
Sex Work
Population Control
Resource Allocation
Confidentiality
Health
Insurance Benefits
Politics

Keywords

  • Asia
  • epidemiology
  • HIV
  • implementation
  • key populations
  • sub-Saharan Africa
  • surveillance
  • viral load

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

@article{e2c32045ef324768a0725f38188bf769,
title = "HIV viral load monitoring among key populations in low- and middle-income countries: Challenges and opportunities: Challenges",
abstract = "Introduction: Key populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population-level, community viral load is a metric of HIV programme effectiveness and can identify {"}hotspots{"} of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations. Discussion: Viral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes. Conclusions: Opportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.",
keywords = "Asia, epidemiology, HIV, implementation, key populations, sub-Saharan Africa, surveillance, viral load",
author = "Sheree Schwartz and Kavanagh, {Matthew M.} and Jeremy Sugarman and Sunil Solomon and Njindam, {Illiassou M.} and Kevin Rebe and Quinn, {Thomas C} and Coumba Toure-Kane and Christopher Beyrer and Stefan Baral",
year = "2017",
month = "11",
day = "1",
doi = "10.1002/jia2.25003",
language = "English (US)",
volume = "20",
pages = "43--49",
journal = "Journal of the International AIDS Society",
issn = "1758-2652",
publisher = "International AIDS Society",

}

TY - JOUR

T1 - HIV viral load monitoring among key populations in low- and middle-income countries

T2 - Challenges and opportunities: Challenges

AU - Schwartz, Sheree

AU - Kavanagh, Matthew M.

AU - Sugarman, Jeremy

AU - Solomon, Sunil

AU - Njindam, Illiassou M.

AU - Rebe, Kevin

AU - Quinn, Thomas C

AU - Toure-Kane, Coumba

AU - Beyrer, Christopher

AU - Baral, Stefan

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Introduction: Key populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population-level, community viral load is a metric of HIV programme effectiveness and can identify "hotspots" of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations. Discussion: Viral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes. Conclusions: Opportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.

AB - Introduction: Key populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population-level, community viral load is a metric of HIV programme effectiveness and can identify "hotspots" of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations. Discussion: Viral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes. Conclusions: Opportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.

KW - Asia

KW - epidemiology

KW - HIV

KW - implementation

KW - key populations

KW - sub-Saharan Africa

KW - surveillance

KW - viral load

UR - http://www.scopus.com/inward/record.url?scp=85034950718&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034950718&partnerID=8YFLogxK

U2 - 10.1002/jia2.25003

DO - 10.1002/jia2.25003

M3 - Article

C2 - 29171178

AN - SCOPUS:85034950718

VL - 20

SP - 43

EP - 49

JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

SN - 1758-2652

ER -