Author: John Sim
Position: Clinical Virologists
Institution: Toga Laboratories (Pty) Ltd
E-mail: sylvia@togalab.co.za
Additional Authors: Des Martin and Jan van den Ende
Submitted Date: December 08, 2006
Published Date: December 11, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

The article by Fiscus et al which appears in the October edition highlights a number of issues related to viral load testing in resource limited settings. Our group was engaged by the HIVForum group earlier this year in a consultative process. It is clear that a number of our views have not been considered. These include:

1) The feasibility of performing high throughput, affordable viral load testing at a primary healthcare level in resource-poor settings

2) Innovative strategies at primary healthcare level including the use of shipping container based laboratories which would provide viral load testing, CD4 testing and monitoring for haematological and other toxicities related to antiretroviral therapies.

a. This approach to testing is best contextualised within the concept of the Autonomous Treatment Centre, a development in which we have had real and extensive experience and which places full HIV management capacity at community level.

3) We have been supporting and performing basic research and development over more than three years in centres situated in Elandsdoom, Mpumalanga and Gugulethu, Cape Town.

4) The performance of these containerised laboratories has been impressive with quality assurance parameters suggesting that there is minimal difference compared to a sophisticated centralised laboratory (log 0.08 mean difference over large number of measurements).

5) These facilities are making a substantial contribution to enhancing peripheral capacity in the health facilities where they are located where they provide appropriate turn around times and forego the need for complicated logistics and reporting.

6) The technology utilised in these laboratories for viral load measurement is also suitable for diagnosis of paediatric HIV infection utilising a cut off of copies per ml, thus eliminating the need for cumbersome filter paper techniques.

7) This iniative has utilised best of breed, approved technologies in a manner which optimises volume related costs and has also demonstrated robustness and reliability, and is free from any contamination issues.

We feel that this innovative approach, which challenges some approaches that are propounded regarding resource poor settings, at least merits further debate and evaluation and should have featured in an article of this nature.

Yours sincerely,

John Sim
Des Martin
Jan van den Ende