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A new model to monitor the virological efficacy of antiretroviral treatment in resource-poor countries.

Colebunders R, Moses KR, Laurence J, Shihab HM, Semitala F, Lutwama F, Bakeera-Kitaka S, Lynen L, Spacek L, Reynolds SJ, Quinn TC, Viner B, Mayanja-Kizza H

Infectious Disease Institute, Faculty of Medicine, Makerere University, Kampala, Uganda. bcoleb@itg.be

Monitoring the efficacy of antiretroviral treatment in developing countries is difficult because these countries have few laboratory facilities to test viral load and drug resistance. Those that exist are faced with a shortage of trained staff, unreliable electricity supply, and costly reagents. Not only that, but most HIV patients in resource-poor countries do not have access to such testing. We propose a new model for monitoring antiretroviral treatment in resource-limited settings that uses patients' clinical and treatment history, adherence to treatment, and laboratory indices such as haemoglobin level and total lymphocyte count to identify virological treatment failure, and offers patients future treatment options. We believe that this model can make an accurate diagnosis of treatment failure in most patients. However, operational research is needed to assess whether this strategy works in practice.

Published 26 December 2005 in Lancet Infect Dis, 6(1): 53-9.
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