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Developing countries face many challenges in achieving the UNAIDS 90:90:90 targets for HIV testing, treatment and viral load (VL) undetectability by 2020.1 Even if a high proportion of patients are diagnosed and put on antiretroviral therapy (ART), the third target requires access to VL testing. The fact is that this is not available to a high proportion of patients in resource-poor countries and most are monitored using clinical assessment or CD4 counts (if available).2 Even when the VL machinery is introduced, lack of maintenance, reagents and skilled staff means that testing is still not done.3 Some WHO member states report that 10% of VL analysers are out of action and only 36% of available capacity is being used.3
The most likely way that these problems will be overcome is by the use of HIV viral load point-of-care testing (VL-POCT).4 If this becomes available at a reasonable cost and the technology proves to be simple and robust, then VL results could be routinely available on the day of testing. This would allow clinical decisions to be made and treatment given before the patient leaves the clinic, as opposed to the several weeks’ gap that is usual for most patients in developing countries, if they get a test at all.2–4 The three situations where this would be most useful are in monitoring for HIV treatment failure, early infant diagnosis (EID) and confirmation of a positive HIV antibody test in pregnancy or …
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