UNASSIGNED: There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. @entity1 typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and @entity404 counts are measured every 6 months, but @entity1 are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the @entity404 count, measurement of the level of @entity645 RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for @entity1 monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future.This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

Sustainable XXXX treatment in Africa through viral-load-informed differentiated care.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity404 :: ('920', 'Gene') :: ['CD4'] @entity645 :: ('57667', 'Species') :: ['HIV']
@entity645 :: (57667,Species) :: ['HIV']
