Viral load monitoring means tracking the level of the virus in a patient’s blood over time. It helps providers see if treatment is working or not and it’s been a standard part of HIV care in developed countries for many years. Until recently, though, it has been deemed too difficult to do in places where MSF works.
Previously, the prohibitively complicated logistics of transporting blood had meant that field clinics in less developed countries could only use the slow, not particularly sensitive CD4 test to gauge the health of the immune system. But MSF teams workers working in Malawi’s Thyolo district found another way when they began collecting spots of blood drawn by finger pricks on filter paper.
The advantages are manifold, says Teri Roberts, MSF diagnostic advisor: the paper needn’t be refrigerated when it’s transported to labs with testing options more advanced than the CD4. The blood spots can be tested in groups of five to reduce the number of tests needed (and if any sample shows a high viral load, the individual samples are retested). Trained community health workers can carry out the finger pricks and collect the samples themselves, which lessens the human resources burden. Most of all, it provides a way to do more effective viral load monitoring on a much wider scale and therefore better understand how patients are responding to treatment.
MSF is also participating in clinical trials of Samba, a device that may enable viral load monitoring in district health centers. “We will hand these projects over to the Ministry of Health at some point, and we want this to be adopted by other regions where MSF is not present,” Roberts says. “We tried to look for very simple, affordable, sustainable, feasible solutions, and this was the way to do it.”