Pooled nucleic acid testing to detect antiretroviral treatment failure in Mexico. Tilghman, M. W., Guerena, D. D., Licea, A., Pérez-Santiago, J., Richman, D. D., May, S., & Smith, D. M. Journal of Acquired Immune Deficiency Syndromes (1999), 56(3):e70–74, March, 2011. doi abstract bibtex BACKGROUND: Similar to other resource-limited settings, cost restricts availability of viral load monitoring for most patients receiving antiretroviral therapy in Tijuana, Mexico. We evaluated if a pooling method could improve efficiency and reduce costs while maintaining accuracy. METHODS: We evaluated 700 patient blood plasma specimens at a reference laboratory in Tijuana for detectable viremia, individually and in 10 × 10 matrix pools. Thresholds for virologic failure were set at ≥500, ≥1000 and ≥1500 HIV RNA copies per milliliter. Detectable pools were deconvoluted using pre-set algorithms. Accuracy and efficiency of the pooling method were compared with individual testing. Quality assurance (QA) measures were evaluated after 1 matrix demonstrated low efficiency relative to individual testing. RESULTS: Twenty-two percent of the cohort had detectable HIV RNA (≥50 copies/mL). Pooling methods saved approximately one third of viral load assays over individual testing, while maintaining negative predictive values of \textgreater90% to detect samples with virologic failure (≥50 copies/mL). One matrix with low relative efficiency would have been detected earlier using the developed QA measures, but its exclusion would have only increased relative efficiency from 39% to 42%. These methods would have saved between $13,223 and $14,308 for monitoring this cohort. CONCLUSIONS: Despite limited clinical data, high prevalence of detectable viral loads and a contaminated matrix, pooling greatly improved efficiency of virologic monitoring while maintaining accuracy. By improving cost-effectiveness, these methods could provide sustainability of virologic monitoring in resource-limited settings, and incorporation of developed QA measures will most likely maximize pooling efficiency in future uses.
@article{tilghman_pooled_2011,
title = {Pooled nucleic acid testing to detect antiretroviral treatment failure in {Mexico}},
volume = {56},
issn = {1944-7884},
doi = {10.1097/QAI.0b013e3181ff63d7},
abstract = {BACKGROUND: Similar to other resource-limited settings, cost restricts availability of viral load monitoring for most patients receiving antiretroviral therapy in Tijuana, Mexico. We evaluated if a pooling method could improve efficiency and reduce costs while maintaining accuracy.
METHODS: We evaluated 700 patient blood plasma specimens at a reference laboratory in Tijuana for detectable viremia, individually and in 10 × 10 matrix pools. Thresholds for virologic failure were set at ≥500, ≥1000 and ≥1500 HIV RNA copies per milliliter. Detectable pools were deconvoluted using pre-set algorithms. Accuracy and efficiency of the pooling method were compared with individual testing. Quality assurance (QA) measures were evaluated after 1 matrix demonstrated low efficiency relative to individual testing.
RESULTS: Twenty-two percent of the cohort had detectable HIV RNA (≥50 copies/mL). Pooling methods saved approximately one third of viral load assays over individual testing, while maintaining negative predictive values of {\textgreater}90\% to detect samples with virologic failure (≥50 copies/mL). One matrix with low relative efficiency would have been detected earlier using the developed QA measures, but its exclusion would have only increased relative efficiency from 39\% to 42\%. These methods would have saved between \$13,223 and \$14,308 for monitoring this cohort.
CONCLUSIONS: Despite limited clinical data, high prevalence of detectable viral loads and a contaminated matrix, pooling greatly improved efficiency of virologic monitoring while maintaining accuracy. By improving cost-effectiveness, these methods could provide sustainability of virologic monitoring in resource-limited settings, and incorporation of developed QA measures will most likely maximize pooling efficiency in future uses.},
language = {eng},
number = {3},
journal = {Journal of Acquired Immune Deficiency Syndromes (1999)},
author = {Tilghman, Myres W. and Guerena, Don Diego and Licea, Alexei and Pérez-Santiago, Josué and Richman, Douglas D. and May, Susanne and Smith, Davey M.},
month = mar,
year = {2011},
pmid = {21124228},
pmcid = {PMC3039117},
keywords = {Drug Monitoring, HIV, HIV Infections, Humans, Mexico, Plasma, RNA, Viral, Specimen Handling, Treatment Failure, Viral Load},
pages = {e70--74},
}
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Thresholds for virologic failure were set at ≥500, ≥1000 and ≥1500 HIV RNA copies per milliliter. Detectable pools were deconvoluted using pre-set algorithms. Accuracy and efficiency of the pooling method were compared with individual testing. Quality assurance (QA) measures were evaluated after 1 matrix demonstrated low efficiency relative to individual testing. RESULTS: Twenty-two percent of the cohort had detectable HIV RNA (≥50 copies/mL). Pooling methods saved approximately one third of viral load assays over individual testing, while maintaining negative predictive values of \\textgreater90% to detect samples with virologic failure (≥50 copies/mL). One matrix with low relative efficiency would have been detected earlier using the developed QA measures, but its exclusion would have only increased relative efficiency from 39% to 42%. These methods would have saved between $13,223 and $14,308 for monitoring this cohort. CONCLUSIONS: Despite limited clinical data, high prevalence of detectable viral loads and a contaminated matrix, pooling greatly improved efficiency of virologic monitoring while maintaining accuracy. By improving cost-effectiveness, these methods could provide sustainability of virologic monitoring in resource-limited settings, and incorporation of developed QA measures will most likely maximize pooling efficiency in future uses.","language":"eng","number":"3","journal":"Journal of Acquired Immune Deficiency Syndromes (1999)","author":[{"propositions":[],"lastnames":["Tilghman"],"firstnames":["Myres","W."],"suffixes":[]},{"propositions":[],"lastnames":["Guerena"],"firstnames":["Don","Diego"],"suffixes":[]},{"propositions":[],"lastnames":["Licea"],"firstnames":["Alexei"],"suffixes":[]},{"propositions":[],"lastnames":["Pérez-Santiago"],"firstnames":["Josué"],"suffixes":[]},{"propositions":[],"lastnames":["Richman"],"firstnames":["Douglas","D."],"suffixes":[]},{"propositions":[],"lastnames":["May"],"firstnames":["Susanne"],"suffixes":[]},{"propositions":[],"lastnames":["Smith"],"firstnames":["Davey","M."],"suffixes":[]}],"month":"March","year":"2011","pmid":"21124228","pmcid":"PMC3039117","keywords":"Drug Monitoring, HIV, HIV Infections, Humans, Mexico, Plasma, RNA, Viral, Specimen Handling, Treatment Failure, Viral Load","pages":"e70–74","bibtex":"@article{tilghman_pooled_2011,\n\ttitle = {Pooled nucleic acid testing to detect antiretroviral treatment failure in {Mexico}},\n\tvolume = {56},\n\tissn = {1944-7884},\n\tdoi = {10.1097/QAI.0b013e3181ff63d7},\n\tabstract = {BACKGROUND: Similar to other resource-limited settings, cost restricts availability of viral load monitoring for most patients receiving antiretroviral therapy in Tijuana, Mexico. We evaluated if a pooling method could improve efficiency and reduce costs while maintaining accuracy.\nMETHODS: We evaluated 700 patient blood plasma specimens at a reference laboratory in Tijuana for detectable viremia, individually and in 10 × 10 matrix pools. Thresholds for virologic failure were set at ≥500, ≥1000 and ≥1500 HIV RNA copies per milliliter. Detectable pools were deconvoluted using pre-set algorithms. Accuracy and efficiency of the pooling method were compared with individual testing. Quality assurance (QA) measures were evaluated after 1 matrix demonstrated low efficiency relative to individual testing.\nRESULTS: Twenty-two percent of the cohort had detectable HIV RNA (≥50 copies/mL). Pooling methods saved approximately one third of viral load assays over individual testing, while maintaining negative predictive values of {\\textgreater}90\\% to detect samples with virologic failure (≥50 copies/mL). One matrix with low relative efficiency would have been detected earlier using the developed QA measures, but its exclusion would have only increased relative efficiency from 39\\% to 42\\%. These methods would have saved between \\$13,223 and \\$14,308 for monitoring this cohort.\nCONCLUSIONS: Despite limited clinical data, high prevalence of detectable viral loads and a contaminated matrix, pooling greatly improved efficiency of virologic monitoring while maintaining accuracy. By improving cost-effectiveness, these methods could provide sustainability of virologic monitoring in resource-limited settings, and incorporation of developed QA measures will most likely maximize pooling efficiency in future uses.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {Journal of Acquired Immune Deficiency Syndromes (1999)},\n\tauthor = {Tilghman, Myres W. and Guerena, Don Diego and Licea, Alexei and Pérez-Santiago, Josué and Richman, Douglas D. and May, Susanne and Smith, Davey M.},\n\tmonth = mar,\n\tyear = {2011},\n\tpmid = {21124228},\n\tpmcid = {PMC3039117},\n\tkeywords = {Drug Monitoring, HIV, HIV Infections, Humans, Mexico, Plasma, RNA, Viral, Specimen Handling, Treatment Failure, Viral Load},\n\tpages = {e70--74},\n}\n\n\n\n","author_short":["Tilghman, M. W.","Guerena, D. D.","Licea, A.","Pérez-Santiago, J.","Richman, D. D.","May, S.","Smith, D. M."],"key":"tilghman_pooled_2011","id":"tilghman_pooled_2011","bibbaseid":"tilghman-guerena-licea-prezsantiago-richman-may-smith-poolednucleicacidtestingtodetectantiretroviraltreatmentfailureinmexico-2011","role":"author","urls":{},"keyword":["Drug Monitoring","HIV","HIV Infections","Humans","Mexico","Plasma","RNA","Viral","Specimen Handling","Treatment Failure","Viral Load"],"metadata":{"authorlinks":{}},"downloads":0,"html":""},"bibtype":"article","biburl":"https://bibbase.org/zotero/ucsdpirc","dataSources":["q7QJpHKwWD5taSmia"],"keywords":["drug monitoring","hiv","hiv infections","humans","mexico","plasma","rna","viral","specimen handling","treatment failure","viral load"],"search_terms":["pooled","nucleic","acid","testing","detect","antiretroviral","treatment","failure","mexico","tilghman","guerena","licea","pérez-santiago","richman","may","smith"],"title":"Pooled nucleic acid testing to detect antiretroviral treatment failure in Mexico","year":2011}