The impact of adherence counseling incorporating a point of care urine tenofovir assay on virologic suppression among individuals failing tenofovir-lamivudine-dolutegravir: A pre-post intervention study

The impact of adherence counseling incorporating a point of care urine tenofovir assay on virologic suppression among individuals failing tenofovir-lamivudine-dolutegravir: A pre-post intervention study

Objectives: To examine if point-of-care (POC) urine tenofovir testing-informed counseling could be used to improve virologic suppression (VS) among participants with virologic failure (VF) after ≥1 prior round of enhanced adherence counseling (EAC). Methods: Participants were enrolled from 42 clinic...

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Main Authors: Leonard Bikinesi, Matthew A. Spinelli, Ntombizodwa Nyoni, Daniella Mouton, Assegid Mengistu, Jacques Kamangu, Iyaloo Konstantinus, Pearl Kalimugogo, Gram Mutandi, Fekir Negussie, Guohong Wang, Susie Welty, Willi McFarland, R. Suzanne Beard, Jessica Haberer, Suzanne McCluskey, Monica Gandhi, Steven Y. Hong
Format: Article
Language:English
Published: Elsevier 2025-02-01
Series:International Journal of Infectious Diseases
Subjects:
Tenofovir-Lamivudine-Dolutegravir (TLD)
People living with HIV
Virologic suppression
Urine tenofovir assay
Point-of-care assay
Enhanced adherence counseling
Online Access:http://www.sciencedirect.com/science/article/pii/S120197122400403X
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Summary:Objectives: To examine if point-of-care (POC) urine tenofovir testing-informed counseling could be used to improve virologic suppression (VS) among participants with virologic failure (VF) after ≥1 prior round of enhanced adherence counseling (EAC). Methods: Participants were enrolled from 42 clinics across Namibia. At each monthly medication pick-up, participants completed the POC urine test and received EAC informed by this testing (EAC+). If VS was not achieved after 3 months of EAC+, up to 3 additional rounds of EAC+ were provided, with resistance testing at month (M)9. Results: Of 310 potentially eligible participants across 42 clinics in Namibia, we enrolled 211 participants with VF (median age 33 years, 61% female); 195 reached M3 defined as receiving EAC+ and follow-up viral load testing; 169 achieved VS within M3 (87%, P < 0.001) and 97% by M9 (181/186) compared to 40% (22/55) prior to the intervention (P < 0.001). Resistance testing was performed in five remaining participants with VF at M9, of whom 1/5 (20%) developed dolutegravir resistance. Conclusion: The urine tenofovir assay when incorporated into adherence counseling has potential to be a cost-effective intervention among participants failing tenofovir-based regimens, increasing VS to 97% in those failing Tenofovir-Lamivudine-Dolutegravir. Encouraging results of this pre-post intervention will be rigorously tested in a randomized trial.
ISSN:1201-9712

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