Economic analysis of data from the DART trial, published in PLOS ONE, shows that there is little justification for the routine use of laboratory tests to monitor patients on antiretroviral therapy in Africa.
The DART trial looked at whether routine laboratory tests were needed to monitor patients on antiretroviral therapy for HIV in Africa. In high-income countries expensive laboratory tests are used routinely. But laboratory facilities, and the money to pay for them, are both scarce in Africa. The trial found that routine tests for side effects did not lead to any benefits for patients. CD4 tests (to measure how a person’s immune system is doing) did have a small benefit for patients after 2 years on treatment. More information can be found in the video below. The economic analysis, which used the DART results to make predictions for 20 years, showed that for routine CD4 tests to be cost-effective, their costs need to fall below US$3.78. These tests currently cost around $10-20 each in Africa, and are not easily accessible for many people living in rural areas. Routine laboratory tests for side effects were not cost-effective, as they did have any benefits for patients.
Laboratory tests are still important for people living with HIV. But the limited laboratory resources available should be used when a patient has symptoms suggesting problems with side-effects or their immune system, rather than being carried out routinely every 3 months. This would free-up resources to put more people on to life saving treatment. MRC CTU is working with partners in Uganda, Malawi and Zimbabwe on the Lablite project, to see how this can be done in practice.