To mark the 30th anniversary of World AIDS Day, UNAIDS is emphasizing the importance of “knowing your status.” According to the United Nations agency, 3 in 4 people living with HIV/AIDS currently know their status, meaning there are approximately 9.2 million worldwide unknowingly living with the infection and putting others at risk as a result.
“Knowledge is power and it's the power with these numbers to manage your health and your well-being.”— Rachel O’Shea, global product director, Abbott
Global health care technology company Abbott is taking it one step further, saying you need to know more than just your status: Know the numbers behind the infection.
“You need to know your CD4 T-cell count for a healthy immune system and your viral load to ensure viral suppression,” said Rachel O’Shea, global product director at Abbott. “Once diagnosed, it is the next sequential step to better health and a long life.”
While this may sound straightforward, access to these critical numbers is not always easy, especially for those living in low- and middle-income settings where access to basic health services may be sparse.
“We hear how vital these numbers are from both the medical community and people living with HIV,” O’Shea said. “These numbers mean everything. They are so powerful in keeping people engaged with their treatment journey.”
In a conversation with Devex, O’Shea explains the barriers to this knowledge, how these can be overcome, and what the global development community can do to spur on progress in the HIV/AIDS space.
The conversation has been edited for length and clarity.
Can you explain exactly what “knowing your numbers” means and why it is important for people living with HIV to have access to these?
Abbott has rolled out a new point-of-care diagnostic test for HIV/AIDS designed to work in remote and rural settings. The organization's Dr. Kuku Appiah tells Devex how this has the potential to accelerate treatment, prevent transmission, monitor the emergence of drug resistance, and overall, contribute to the UNAIDS 90-90-90 goals.
There are two really important numbers for people living with HIV to know. The first one is their CD4+ number, which essentially tells the person how well their immune system is functioning. For people living with HIV, a number above 500 cells/µL is indicative of good health. This is so important considering the potential susceptibility of people living with HIV to infections that can have life-threatening consequences. CD4+ establishes that baseline immunity.
The second number is their viral load. This tells the patient the amount of virus circulating in their blood. A low viral load for a person living with HIV on antiretroviral treatment indicates that the treatment is effective (threshold 1,000 copies/ml). The World Health Organization recommends viral load testing as the preferred monitoring tool for diagnosing and confirming treatment failure.
The goal of antiretroviral treatment is viral suppression, achieving viral suppression protects the body’s immune system, helping people living with HIV/AIDS stay healthy and prevent transmission to other people.
What are the challenges people living with HIV face in knowing their numbers?
I believe the main challenge is first access to testing and then clinicians and patients receiving their results. We know that effort has been expended to make viral load testing more accessible, however, the latest implementation data shows access to viral load testing to be highly variable — mostly severely limited — with considerable variations in the approaches to treatment monitoring encountered.
Another critical challenge is obtaining results in a timely manner to ensure that clinically a treatment regime is optimal and working well. It is also a means of engagement, knowing that one’s health is being managed, and a motivator for patients to keep taking their medication.
In this case, knowledge is power and it's the power with these numbers to manage health and well-being.
How can these challenges be overcome?
There are a number of things that we at Abbott are doing to help people know their numbers.
To overcome some of the challenges, viral load testing capacity needs to be built up. Countries are currently actively expanding capacity to improve access to testing and Abbott has a complete solution: automated high throughput solutions for the central and molecular laboratories and the new m-PIMA HIV-1/2 VL for point of care viral load. Combined, we have the ability to extend the reach of a lab to decentralized settings and support countries achieving their viral load testing goals.
What we can ensure is that when people living with HIV/AIDS take time out of their busy lives to go to the clinic to get tested, they can leave that same day with the results they need either to continue with their treatment regimens or make changes for better outcomes.
m-PIMA HIV-1/2 VL is the first point-of-care test designed to provide health care professionals with the ability to measure an HIV viral load in less than 70 minutes and can be operated via mains and an external battery.
We can expand access to decentralized settings where testing takes less than 70 minutes, not months, to see if those treatments are working. Ensuring ready access to viral load testing for every person helps health care workers identify adherence challenges early, supporting interventions and the most effective treatment regimens for better health outcomes.
What is needed to ensure that those technologies are accessible to individuals and their doctors?
The innovations are now available. In order to support access, we need the global community to embrace these new innovations removing the barriers to entry when solutions are available.
We all committed a couple of years ago as a global community to help support UNAIDS effort to achieve 90-90-90 by 2020, which is fast approaching.
We need greater political will and funding to expand testing and embrace new technologies that will enable us, as a global community, to deliver on our commitments. We call on implementation partners to step forward and support the delivery of innovation that can truly “fast-track” our efforts.