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Diagnostics
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HIV Diagnosis, Treatment, and Care
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HIV Diagnosis, Treatment, and Care

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Diagnostic Microbiology and Infectious Disease".

Deadline for manuscript submissions: closed (30 November 2020) | Viewed by 21630

Special Issue Editor

Dr. Brooke Nichols

E-Mail Website
Guest Editor
Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
Interests: mathematical modeling; HIV prevention; HIV treatment; geospatial modeling; health economics; HIV diagnostics

Special Issue Information

Dear Colleagues,

UNAIDS has set the “95–95–95” goal to be reached by 2030, in which 95% of patients infected with HIV are aware of their status, 95% of those patients are on antiretroviral treatment, and 95% of those are virally suppressed. Diagnostics play a key role in attaining these goals by enabling diagnosis of HIV and monitoring of patients on treatment. There have been rapid developments in HIV diagnostics, leading to the development and increasing availability of rapid and point-of-care technologies to improve both identification of new HIV positives and HIV-positive patients on or entering HIV care with antiretroviral treatment. These diagnostics include the use of HIV self-testing for HIV screening, point-of-care viral load technologies to monitor patients on treatment, and identification of advanced HIV disease. Through the utilization of these technologies, there is the possibility to increase the number of people testing for HIV and improve patient outcomes by enabling rapid clinical response to patient monitoring tests. These technologies are also typically less expensive and can improve access to diagnostics by enabling task-shifting to a lower cadre of staff, which is of particular importance in highly resource-constrained low- and middle-income countries (LMIC).

The goal of this Special Issue is to gain insights into how the utilization of new diagnostics in HIV diagnosis, HIV treatment, and monitoring affects patient care and health outcomes in LMIC, including cost and impact of bringing these technologies to scale and their effect on patient access to diagnostics.

Dr. Brooke Nichols
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • HIV self-test
  • HIV diagnostics
  • Viral load
  • Advanced HIV disease
  • CrAG
  • CD4 cell count
  • Point of care
  • Rapid test
  • Evaluation
  • Health economics

Published Papers (7 papers)

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Research

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10 pages, 231 KiB  
Article
Individual- and Facility-Level Factors Associated with Facility Testing among Men in Malawi: Findings from a Representative Community Survey
by Kelvin Balakasi, Brooke E. Nichols, Misheck Mphande, Christian Stillson, Shaukat Khan, Pericles Kalande, Isabella Robson, Maria Sanena, Khumbo Ng’ona, Joep J. van Oosterhout, Naoko Doi and Kathryn Dovel
Diagnostics 2021, 11(6), 950; https://doi.org/10.3390/diagnostics11060950 - 26 May 2021
Cited by 2 | Viewed by 1917
Abstract
(1) Background: Men frequent outpatient departments (OPD) but are underrepresented in HIV testing services throughout sub-Saharan Africa. (2) Methods: We conducted a secondary analysis on data from a community-based survey with men in rural Malawi to assess factors associated with HIV testing, and [...] Read more.
(1) Background: Men frequent outpatient departments (OPD) but are underrepresented in HIV testing services throughout sub-Saharan Africa. (2) Methods: We conducted a secondary analysis on data from a community-based survey with men in rural Malawi to assess factors associated with HIV testing, and being offered testing, during men’s OPD visits. We include OPD visits made by men in-need of testing as our unit of observation. Multilevel mixed-effects logistic regression models were conducted. (3) Results: 782 men were eligible for these analyses, with 1575 OPD visits included (median two visits per man; IQR 1–3). 17% of OPD visits resulted in HIV testing. Being offered testing (aOR 42.45; 95% CI 15.13–119.10) and satisfaction with services received (aOR 3.27; 95% CI 1.28–8.33) were significantly associated with HIV testing. 14% of OPD visits resulted in being offered HIV testing. Being married/steady relationship (aOR 2.53; 95% CI 1.08–5.91) and having a sexual partner living with HIV (aOR 8.22; 95% CI 1.67–40.49) were significantly associated with being offered testing. (4) Conclusion: Being offered HIV testing was the strongest factor associated with testing uptake, while HIV status of sexual partner had the strongest association with being offered testing. Implementation of provider-initiated-testing should be prioritized for male OPD visits. Full article
(This article belongs to the Special Issue HIV Diagnosis, Treatment, and Care)
15 pages, 1425 KiB  
Article
Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old
by Mutita Siriruchatanon, Shan Liu, James G. Carlucci, Eva A. Enns and Horacio A. Duarte
Diagnostics 2021, 11(3), 567; https://doi.org/10.3390/diagnostics11030567 - 21 Mar 2021
Cited by 1 | Viewed by 2460
Abstract
Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with [...] Read more.
Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with perinatally acquired HIV in sub-Saharan Africa who initiate ART at 3 years of age. We evaluated the cost-effectiveness of diagnostic-based strategies (improved switching and PDR testing), over a 10-year time horizon, in settings without and with pediatric dolutegravir (DTG) availability as first-line ART. The improved switching strategy increases the probability of switching to second-line ART when virologic failure is diagnosed through viral load testing. The PDR testing strategy involves a one-time PDR test prior to ART initiation to guide choice of initial regimen. When DTG is not available, PDR testing is dominated by the improved switching strategy, which has an incremental cost-effectiveness ratio (ICER) of USD 579/life-year gained (LY), relative to the status quo. If DTG is available, improved switching has a similar ICER (USD 591/LY) relative to the DTGstatus quo. Even when substantial financial investment is needed to achieve improved regimen switching practices, the improved switching strategy still has the potential to be cost-effective in a wide range of sub-Saharan African countries. Our analysis highlights the importance of strengthening existing laboratory monitoring systems to improve the health of children living with HIV. Full article
(This article belongs to the Special Issue HIV Diagnosis, Treatment, and Care)
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18 pages, 2301 KiB  
Article
The Development of a Standardized Quality Assessment Material to Support Xpert® HIV-1 Viral Load Testing for ART Monitoring in South Africa
by Lara Dominique Noble, Lesley Erica Scott, Asiashu Bongwe, Pedro Da Silva and Wendy Susan Stevens
Diagnostics 2021, 11(2), 160; https://doi.org/10.3390/diagnostics11020160 - 22 Jan 2021
Viewed by 3140
Abstract
The tiered laboratory framework for human immunodeficiency virus (HIV) viral load monitoring accommodates a range of HIV viral load testing platforms, with quality assessment critical to ensure quality patient testing. HIV plasma viral load testing is challenged by the instability of viral RNA. [...] Read more.
The tiered laboratory framework for human immunodeficiency virus (HIV) viral load monitoring accommodates a range of HIV viral load testing platforms, with quality assessment critical to ensure quality patient testing. HIV plasma viral load testing is challenged by the instability of viral RNA. An approach using an RNA stabilizing buffer is described for the Xpert® HIV-1 Viral Load (Cepheid) assay and was tested in remote laboratories in South Africa. Plasma panels with known HIV viral titres were prepared in PrimeStore molecular transport medium for per-module verification and per-instrument external quality assessment. The panels were transported at ambient temperatures to 13 testing laboratories during 2017 and 2018, tested according to standard procedures and uploaded to a web portal for analysis. A total of 275 quality assessment specimens (57 verification panels and two EQA cycles) were tested. All participating laboratories met study verification criteria (n = 171 specimens) with an overall concordance correlation coefficient (ρc) of 0.997 (95% confidence interval (CI): 0.996 to 0.998) and a mean bias of −0.019 log copies per milliliter (cp/mL) (95% CI: −0.044 to 0.063). The overall EQA ρc (n = 104 specimens) was 0.999 (95% CI: 0.998 to 0.999), with a mean bias of 0.03 log cp/mL (95% CI: 0.02 to 0.05). These panels are suitable for use in quality monitoring of Xpert® HIV-1 VL and are applicable to laboratories in remote settings. Full article
(This article belongs to the Special Issue HIV Diagnosis, Treatment, and Care)
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13 pages, 597 KiB  
Article
Feasibility of Four Interventions to Improve Treatment Adherence in Migrants Living with HIV in The Netherlands
by Sabrina K. Been, David A.M.C. van de Vijver, Jannigje Smit, Nadine Bassant, Katalin Pogány, Sarah E. Stutterheim and Annelies Verbon
Diagnostics 2020, 10(11), 980; https://doi.org/10.3390/diagnostics10110980 - 20 Nov 2020
Cited by 4 | Viewed by 2665
Abstract
We evaluated the feasibility and efficacy of four existing interventions to improve adherence to them in migrants living with HIV (MLWH): directly administered antiretroviral therapy (DAART), group medical appointments (GMA), early detection and treatment of psychological distress, and peer support by trained MLWH. [...] Read more.
We evaluated the feasibility and efficacy of four existing interventions to improve adherence to them in migrants living with HIV (MLWH): directly administered antiretroviral therapy (DAART), group medical appointments (GMA), early detection and treatment of psychological distress, and peer support by trained MLWH. At baseline and after the interventions, socio-demographic characteristics, psychosocial variables, and data on HIV treatment adherence were collected. The two questionnaires were completed by 234/301 (78%) MLWH included at baseline. Detectable HIV RNA decreased (from 10.3 to 6.8%) as did internalized HIV-related stigma (from 15 to 14 points), and self-reported adherence increased (between 5.5 and 8.3%). DAART and GMA were not feasible interventions. Screening of psychological distress was feasible; however, follow-up diagnostic screening and linkage to psychiatric services were not. Peer support for and by MLWH was feasible. Within this small intervention group, results on HIV RNA < 400 copies/mL (decrease of 23.6%) and outpatient clinic attendance (up to 20.4% kept more appointments) were promising. Full article
(This article belongs to the Special Issue HIV Diagnosis, Treatment, and Care)
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12 pages, 310 KiB  
Article
The Role of Mental Health Conditions in the Diagnosis of Neurocognitive Impairment in People Living with HIV
by Irene Portilla-Tamarit, Nicolás Ruiz-Robledillo, Marcos Díez-Martínez, Rosario Ferrer-Cascales, Cristian Alcocer-Bruno and Joaquín Portilla
Diagnostics 2020, 10(8), 543; https://doi.org/10.3390/diagnostics10080543 - 30 Jul 2020
Viewed by 2034
Abstract
The aims of the present study were to evaluate the prevalence of undiagnosed mental health conditions (UMHC) in people living with HIV (PLWHIV) on antiretroviral treatment and with long-term suppressed HIV viremia, and its association with neurocognitive impairment (NCI). A cross-sectional observational study [...] Read more.
The aims of the present study were to evaluate the prevalence of undiagnosed mental health conditions (UMHC) in people living with HIV (PLWHIV) on antiretroviral treatment and with long-term suppressed HIV viremia, and its association with neurocognitive impairment (NCI). A cross-sectional observational study on HIV subjects, ≥18 years old, on stable antiretroviral treatment and with HIV viral load <50 copies/mL was carried out. Patients with known comorbidities, substances abuse, anxiety or depression were excluded. UMHC were evaluated by the Millon Clinical Multiaxial Inventory-III and NCI by Frascati criteria. The association between NCI and sociodemographic, clinical HIV variables and mental health conditions was analyzed. Further, the relationship between mental health conditions scores and NCI diagnosis was evaluated. Eighty patients were included, 37.5% had at least one undiagnosed mental health condition, and 26.3% had NCI. The most frequent mental health conditions were: anxiety (21.3%); bipolar disorder (11.3%); and substance dependence (8.8%). Only longer time since HIV diagnosis (p = 0.030) and at least one mental health condition diagnosis (p = 0.002) showed an association with NCI. Participants with NCI presented higher scores in anxiety, alcohol dependence and post-traumatic stress. Undiagnosed mental health conditions are frequent in PLWHIV. These disorders cannot be identified by HIV clinicians or basic screening questionnaires, and they are not usually self-reported by patients. UMHC could act as confounders in the evaluation of NCI. Full article
(This article belongs to the Special Issue HIV Diagnosis, Treatment, and Care)
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10 pages, 1070 KiB  
Article
Costs of Providing HIV Self-Test Kits to Pregnant Women Living with HIV for Secondary Distribution to Male Partners in Uganda
by Michelle A. Bulterys, Andrew Mujugira, Agnes Nakyanzi, Miriam Nampala, Geoffrey Taasi, Connie Celum and Monisha Sharma
Diagnostics 2020, 10(5), 318; https://doi.org/10.3390/diagnostics10050318 - 19 May 2020
Cited by 9 | Viewed by 3105
Abstract
Background: Secondary distribution of HIV self-testing kits (HIVST) to pregnant women attending antenatal care (ANC) clinics to give to their male partners is a promising strategy to increase testing coverage among men, but its costs are unknown. Methods: We conducted micro-costing of a [...] Read more.
Background: Secondary distribution of HIV self-testing kits (HIVST) to pregnant women attending antenatal care (ANC) clinics to give to their male partners is a promising strategy to increase testing coverage among men, but its costs are unknown. Methods: We conducted micro-costing of a trial evaluating secondary distribution of HIVST on pregnant women living with HIV (PWLHIV) in an ANC in Kampala, Uganda. Costs (2019 USD) were collected from program budgets, expenditure records, time and motion observations, and staff interviews and estimated for three scenarios: as-studied, reflecting full costs of the research intervention, Ministry of Health (MOH) implementation, reflecting the research intervention if implemented by the MOH, and MOH roll-out, the current strategy being used to roll out HIVST distribution. Results: In the as-studied scenario, cost of HIVST provision was $13.96/PWLHIV reached, and $11.89 and $10.55 per HIV-positive and HIV-negative male partner, respectively, who linked to a clinic for facility-based testing. In the MOH implementation scenario, costs were $9.45/PWLHIV, and $7.87 and $6.99, respectively, per HIV-positive and HIV-negative male partner linking to the clinic. In the MOH roll-out scenario, the cost of HIVST provision to pregnant women regardless of HIV status was $3.70/woman, and $6.65/HIV-positive male partner. Conclusion: Secondary distribution of HIVST from pregnant women can be implemented at reasonable cost to increase testing among men in Uganda and similar settings in Africa. Full article
(This article belongs to the Special Issue HIV Diagnosis, Treatment, and Care)
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Review

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10 pages, 638 KiB  
Review
Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions
by Kameko Nichols, Sarah J. Girdwood, Andrew Inglis, Pascale Ondoa, Karla Therese L. Sy, Mariet Benade, Aloysius Bingi Tusiime, Kekeletso Kao, Sergio Carmona, Heidi Albert and Brooke E. Nichols
Diagnostics 2021, 11(1), 22; https://doi.org/10.3390/diagnostics11010022 - 24 Dec 2020
Cited by 11 | Viewed by 5483
Abstract
Diagnostics services are an essential component of healthcare systems, advancing universal health coverage and ensuring global health security, but are often unavailable or under-resourced in low- and middle-income (LMIC) countries. Typically, diagnostics are delivered at various tiers of the laboratory network based on [...] Read more.
Diagnostics services are an essential component of healthcare systems, advancing universal health coverage and ensuring global health security, but are often unavailable or under-resourced in low- and middle-income (LMIC) countries. Typically, diagnostics are delivered at various tiers of the laboratory network based on population needs, and resource and infrastructure constraints. A diagnostic network additionally incorporates screening and includes point-of-care testing that may occur outside of a laboratory in the community and clinic settings; it also emphasizes the importance of supportive network elements, including specimen referral systems, as being critical for the functioning of the diagnostic network. To date, design and planning of diagnostic networks in LMICs has largely been driven by infectious diseases such as TB and HIV, relying on manual methods and expert consensus, with a limited application of data analytics. Recently, there have been efforts to improve diagnostic network planning, including diagnostic network optimization (DNO). The DNO process involves the collection, mapping, and spatial analysis of baseline data; selection and development of scenarios to model and optimize; and lastly, implementing changes and measuring impact. This review outlines the goals of DNO and steps in the process, and provides clarity on commonly used terms. Full article
(This article belongs to the Special Issue HIV Diagnosis, Treatment, and Care)
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