A randomized clinical trial led by Johns Hopkins researchers finds that giving patients a next-day HIV viral load (VL) test result didn’t improve rates of care-seeking for antiretroviral therapy (ART) or HIV preexposure prophylaxis (PrEP).
Published in JAMA Network Open, the study assessed whether giving lab-based HIV VL test results within 24 hours would change linkage-to-care (LTC) rates over 12 weeks of follow-up.
A convenience sample of 195 adults with risk factors for HIV infection (eg, multiple sexual partners) or those with HIV not taking daily ART were enrolled from August 2021 to February 2023.
Participants were recruited from an emergency department in Baltimore, Maryland, a social media advertising campaign, and other sources. The median patient age was 36 years, 61.0% were men, 57.4% were Black, 26.2% were White, 16.4% were of another race, and 17.4% had HIV.
The study authors noted that while point-of-care HIV VL tests are used in other countries, they are not approved for use in the United States.
“Access to an HIV VL test result may improve health care professional–patient communication and can inform clinical decision-making,” they wrote. “Clinicians may be more likely to initiate PrEP for a patient recently exposed to HIV with a negative VL test result.”
Faster feedback may trigger patients to seek care
In total, 47.7% of participants completed follow-up, and 35.4% were linked to care (55.1% in the intervention group, who received next-day HIV VL testing and HIV antigen/antibody detection vs 44.9% of controls, who received only the latter). The median time to receipt of test results was 6 hours for standard testing and 26 hours for viral load testing.
There was no statistically significant difference in LTC between the intervention and control group (hazard ratio, 1.28). In a modified intention-to-treat analysis, time to LTC was significantly less for HIV patients who received the intervention.
“Overall, we found there was no difference in linkage to care rates between the groups, suggesting that knowing the results of a viral load test does not significantly improve the rates by which people seek treatment or prevention care for HIV,” senior author Yukari Manabe, MD, of Johns Hopkins, said in a university news release.
