HIV Viral Load Trends in Six Eastern Caribbean Countries Utilizing a Regional Laboratory Referral Service: Implications for Treatment as Prevention

Since 2009, seven countries in the Organization of Eastern Caribbean States (OECS), Antigua & Barbuda, Dominica, Grenada, Montserrat, St. Kitts & Nevis, Saint Lucia, and St. Vincent & the Grenadines, have been utilizing a laboratory referral service for HIV-1 viral load (VL) offered by T...

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Bibliographic Details
Published in:PloS one 2015-04, Vol.10 (4), p.e0125435-e0125435
Main Authors: Landis, R Clive, Carmichael-Simmons, Kelly, Hambleton, Ian R, Best, Anton
Format: Article
Language:English
Subjects:
Blood
Clinical Laboratory Techniques
Demographic aspects
Diagnosis
Feasibility studies
Female
HIV
HIV infections
HIV Infections - blood
HIV Infections - epidemiology
HIV Infections - prevention & control
HIV tests
Human immunodeficiency virus
Humans
Male
Monitoring
Prevention
Public health
Rejection rate
Reverse Transcriptase Polymerase Chain Reaction
RNA, Viral - blood
Sample rejection
Sampling methods
Software
Trends
Viral Load
West Indies - epidemiology
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Summary:Since 2009, seven countries in the Organization of Eastern Caribbean States (OECS), Antigua & Barbuda, Dominica, Grenada, Montserrat, St. Kitts & Nevis, Saint Lucia, and St. Vincent & the Grenadines, have been utilizing a laboratory referral service for HIV-1 viral load (VL) offered by The Ladymeade Reference Unit (LRU) Laboratory, Barbados. The objective of this study was to evaluate 5 year VL trends in the six larger OECS countries participating in this regional referral service. Blood samples were collected in source countries and transported to Barbados as frozen plasma according to a standardized protocol. Plasma specimens were amplified by RT PCR on a Roche TaqMan 48 analyser (Roche Diagnostics, Panama City, Panama). VL was considered optimally suppressed below a threshold level of < 200 HIV-1 copies/mL of blood. The same threshold was used as a binary indicator in an analysis of the secular change in VL suppression. Montserrat was excluded due to insufficient number of samples. A steady rise in VL referrals from OECS countries was recorded, rising from 312 samples in 2009 to 1,060 samples in 2013. A total of 3,543 samples were tested, with a sample rejection rate (9.2%) mostly due to breaks in the cold chain. Aggregate VL data showed the odds of VL suppression in the Eastern Caribbean improved by 66% for each additional year after 2009 (Odds Ratio 1.66 [95% CI 1.46 to 1.88]; p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0125435