Researchers from the University of the Witwatersrand, South Africa’s National Health Laboratory Service and University Medical Center Utrecht studied a new strategy for people whose HIV viral load rises while taking dolutegravir, a standard antiretroviral. The ITREMA-2 study, published in The Lancet HIV, involved 288 people at two public facilities in Johannesburg.
The method relies on a blood test that checks whether the drug is present. If it is absent, the rising viral load is probably due to missed doses and the patient needs adherence support; if it is present and the virus is still multiplying, a resistance test is needed.
In this way, clinicians avoid carrying out costly resistance tests on every patient, identify sooner who really needs them and target counselling more effectively. The researchers estimated that laboratory monitoring costs were 23% lower than under the previous approach.
South Africa’s Department of Health has already adopted an adapted version of the strategy in public HIV care.
