HIV Viral Load Testing in Laos

The number of people living with HIV/AIDS in the People’s Democratic Republic of Laos (also known as Laos PDR) is estimated at 13,600 and the number of people in need of antiretroviral therapy at 8,000. Today, around 3,200 HIV infected individuals receive treatment in seven centres throughout the country. Until recently, antiretroviral treated patients were followed-up only on the basis of clinical and immunological criteria. In 2009 the Centre d'Infectiologie Christophe Mérieux in Laos PDR (CICML) signed a collaboration agreement with the national Centre of HIV/AIDS/STI (CHAS) for the implementation of HIV viral load testing (VLT) in the country, leading to the technological transfer of the ANRS generic assay (HIV Generic charge virale, Biocentric, Bandol, France). The introduction of HIV VLT has been accompanied through national HIV workshops every 6 months. From June 2009 to December 2011, HIV viral load has been measured in 1,782 antiretoviral-treated patients. Of these, 97% were on reverse-transcriptase inhibitor -based 1st line regimen. HIV viral load was undetectable (<250 copies/ml) for 1,491 out of 1,782 (84%) antiretroviral-treated patients. Four months after adherence strengthening, HIV viral load became undetectable for 179/247 patients (72.5%) while 68/247 patients (27.5%) remained viremic (median viral load: 4.1 Log10). This report demonstrates the feasibility of setting up an affordable HIV viral load generic test at a national level in Laos PDR. Interestingly, only 16% of antiretroviral-treated patients presented with detectable VL at their first viral load measurement. Importantly, almost two thirds of them have controlled their viral load after strengthening their adherence to treatment.La République démocratique populaire du Laos compterait 13 600 personnes atteintes du VIH/SIDA dont 8000 auraient besoin d’un traitement antirétroviral. Aujourd’hui, environ 3200 individus infectés par le VIH reçoivent un traitement dans sept centres répartis dans tout le pays. Jusqu’à récemment, le suivi des patients traités par antirétroviraux se faisait uniquement sur la base de critères cliniques et immunologiques. En 2009, le Centre d'Infectiologie Christophe Mérieux du Laos (CICML) a signé un accord de collaboration avec le Programme national SIDA du Laos (CHAS) pour la mise en œuvre de tests de détection de la charge virale de VIH (VLT) dans le pays, qui permettra le transfert technologique de la technique générique ANRS (HIV Generic charge virale, Biocentric, Bandol, France). L’introduction du VLT appliqué au VIH s’est faite au travers d’ateliers nationaux sur le VIH tous les 6 mois. De juin 2009 à décembre 2011, la charge virale de VIH a été mesurée chez 1782 patients traités par antirétroviraux. Parmi eux, 97 % prenaient un traitement de première intention à base d’inhibiteur de la transcriptase inverse. La charge virale de VIH était indétectable (<250 copies/ml) chez 1491 des 1782 (84 %) patients traités par antirétroviraux. Quatre mois après renforcement de l’administration du traitement, la charge virale de VIH est devenue indétectable chez 179/247 patients (72,5 %) tandis que 68/247 patients (27,5 %) sont demeurés virémiques (charge virale médiane : 4,1 Log10). Cet article montre la faisabilité de la mise en place d’un test de détection générique de la charge virale de VIH abordable au niveau national au Laos. Il est intéressant de noter que seuls 16 % des patients traités par antirétroviraux ont présenté une charge virale détectable lors de la première mesure. En outre, près des deux-tiers d’entre eux ont pu maîtriser leur charge virale par une meilleure administration du traitement.El número de personas que padecen VIH/SIDA en la República Democrática Popular de Laos (también conocida como RDP Lao) se estima en 13.600, y el número de personas que necesitan un tratamiento antirretroviral es de 8.000. En la actualidad, cerca de 3.200 personas infectadas por el VIH reciben tratamiento en siete centros repartidos por todo el país. Hasta hace poco, el seguimiento de los pacientes tratados con fármacos antirretrovirales dependía exclusivamente de criterios clínicos e inmunológicos. En el 2009, el Centro de Infectología Christophe Mérieux de PDR Lao (CICML) suscribió un acuerdo de colaboración con el Centro Nacional de VIH/SIDA/ITS (CHAS) para la implantación del estudio de la carga viral del VIH (VLT, por sus siglas en inglés) en el país, lo que comportaría la transferencia de la tecnología del ensayo genérico ANRS (carga viral genérica del VIH, Biocentric, Bandol, Francia). La introducción del estudio de la carga viral del VIH se ha visto respaldada por la realización de varios talleres nacionales sobre el VIH cada 6 meses. Desde junio de 2009 a diciembre de 2011 se ha medido la carga vírica del VIH de 1.782 pacientes tratados con antirretrovirales. El 97 % de ellos seguía un régimen antirretroviral de primera línea basado en inhibidores de la transcriptasa inversa. No se detectó carga viral del VIH (<250 copias/ml) en 1.491 de 1.782 (84 %) de los pacientes tratados con antirretrovirales. Cuatro meses después del fortalecimiento de la adherencia, no se detectó carga viral del VIH en 179 de 247 pacientes (72,5 %) mientras que 68 de 247 pacientes (27,5 %) seguían siendo virémicos (carga viral media: 4,1 Log10). Este informe demuestra la viabilidad de elaborar un estudio genérico de la carga viral del VIH económico a nivel nacional en la RDP Lao). Cabe destacar que solamente el 16 % de los pacientes tratados con antirretrovirales presentaron una carga viral detectable en su primera medición de la carga viral. Es significativo que casi dos terceras partes de ellos hayan conseguido controlar su carga viral después de fortalecer su adherencia al tratamiento

Installing biosafety level 3 containment laboratories in low- and middle-income countries: challenges and prospects from Mali's experience

In Mali, the incidence of tuberculosis (TB) is estimated at 56 cases per 100 000 people, with a prevalence of multidrug-resistant TB in new cases of 1.7% (range, 0.3–3.1%) and in retreatment cases of 17% (range, 4.4–30%). Appropriate biosafety conditions for performing routine TB culture and antimicrobial susceptibility testing have been lacking. In 2015, a biosafety level 3 (BSL3) laboratory set up in a shipping container was donated to the Malian Ministry of Health and Public Hygiene to provide capacity for TB testing. This laboratory is now managed by Malian laboratory staff and is processing samples at the national level. We explain the necessary steps for establishing and running a BSL3 laboratory. Despite the acute need for functioning and sustainable BSL3 laboratories, low- and middle-income countries are faced with a complex process and must overcome many challenges. Keywords: biosafety, BSL3, capacity-building, culture, DST, LMICs, Mali, Tuberculosi

HIV Viral Load Testing in Laos

The number of people living with HIV/AIDS in the People’s Democratic Republic of Laos (also known as Laos PDR) is estimated at 13,600 and the number of people in need of antiretroviral therapy at 8,000. Today, around 3,200 HIV infected individuals receive treatment in seven centres throughout the country. Until recently, antiretroviral treated patients were followed-up only on the basis of clinical and immunological criteria. In 2009 the Centre d'Infectiologie Christophe Mérieux in Laos PDR (CICML) signed a collaboration agreement with the national Centre of HIV/AIDS/STI (CHAS) for the implementation of HIV viral load testing (VLT) in the country, leading to the technological transfer of the ANRS generic assay (HIV Generic charge virale, Biocentric, Bandol, France). The introduction of HIV VLT has been accompanied through national HIV workshops every 6 months. From June 2009 to December 2011, HIV viral load has been measured in 1,782 antiretoviral-treated patients. Of these, 97% were on reverse-transcriptase inhibitor -based 1st line regimen. HIV viral load was undetectable (&#60;250 copies/ml) for 1,491 out of 1,782 (84%) antiretroviral-treated patients. Four months after adherence strengthening, HIV viral load became undetectable for 179/247 patients (72.5%) while 68/247 patients (27.5%) remained viremic (median viral load: 4.1 Log10). This report demonstrates the feasibility of setting up an affordable HIV viral load generic test at a national level in Laos PDR. Interestingly, only 16% of antiretroviral-treated patients presented with detectable VL at their first viral load measurement. Importantly, almost two thirds of them have controlled their viral load after strengthening their adherence to treatment