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There is growing demand within the global health community to find ways to simplify and improve the efficiency of diagnostics for HIV/AIDS without diminishing the quality of patient care. At the same time, there is a need to significantly increase the level of access to robust, high-quality diagnostics in resourcelimited settings in order to facilitate early detection and treatment of HIV/AIDS.
Of the various tests required for initial diagnosis, staging and ongoing monitoring of HIV, those that present the most persistent challenges to improved access and efficiency are CD4, viral load and early infant diagnosis (EID). This report reviews both current diagnostic platforms and pipeline technologies for these three key tests. For each, the great majority of testing options available today is still laboratory-based platforms performed on sophisticated instrumentation requiring dedicated laboratory space and trained laboratory technicians. In many cases, laboratory-based testing is expensive; in almost all cases, it requires sample transport networks to enable access for patients in peri-urban and rural settings.
Given the limitations of laboratory-based testing, it is generally accepted that in order to improve access to, and reduce the cost of CD4, viral load and EID testing in resource-limited settings, such testing needs to be brought closer to the site of patient care.
This report reviews the current technology landscape for HIV diagnostics, including: (i) the algorithms and tests required in HIV/AIDS care and treatment, both before and after treatment initiation; (ii) the platforms used and price points of that testing; and (iii) the ways in which testing is delivered. With this information as background, the report then reviews the current technologies and diagnostic platforms in three key testing areas: CD4 and viral load testing for adults and children as well as early infant diagnosis (EID) (including EID run on viral load platforms) – all of which today are accessed typically through sophisticated laboratory-based testing platforms, even in resource-limited settings. The report describes POC and near-POC CD4, viral load and EID platforms on the market and in the development pipeline, and considers the implications of the landscape, including what efficiencies might be achieved with respect to test algorithms, the cost of testing and decentralized service delivery.
You can downloand the HIV/AIDS diagnostics technology landscape from 2014 and the semi-annual update published last January 2015 by clicking in the links on the top right corner of the page.
This technical report was produced by UNITAID (www.unitaid.org), an organisation hosted and administered by the WHO, which uses innovative financing to increase funding for greater access to treatments and diagnostics for HIV/AIDS, malaria and tuberculosis in low-income countries.
This resource was originally posted in Global Health Laboratories.