A team of expert researchers, including Senior Medical Officer of Health, Dr. Anton Best, and Professor Clive Landis of UWI’s Chronic Disease Research Centre, have concluded that the island has scored some major successes in the suppression of viral load in patients with the disease.
And they are attributing the positive outcome to availability and efficient use of antiretroviral drugs in Barbados.
In the medical fraternity viral load generally refers to the amount of HIV there is in your blood, information which is key to monitoring the illness, and prescribing treatments.
Based on their study called “Ten Year Trends in Community Viral Load In Barbados – Implications For Treatment As Prevention”, Best, Landis, and colleagues from CDRC and The Ladymeade Reference Unit, which is the national HIV treatment centre, concluded that there was “a statistically significant downward trend in community VL amongst the LRU client population over a 10-year period.
“Analysis of VL trends showed a statistically significant improvement in VL suppression between 2002 to 2011, from 33.6 per cent of clients achieving the 200 copies/mL threshold in 2002 to 70.3 per cent in 2011,” they reported.
“Taking into account the proportion of clients alive and in care and on anti retroviral treatment, the known diagnosed HIV population in Barbados, and estimates of unknown HIV infections, this translates into an estimated 26.2 per cent VL suppression at a population level at the end of 2010.”
The medical officials said these estimates of VL suppression were comparable to those of developed countries that applied similar methodologies and they noted that this “could suggest a public health benefit of antiretroviral treatment in minimising the risk of sexual transmission of HIV”.
But they also believed that “continued efforts are warranted to extend HIV testing to hidden populations in Barbados and linking infected persons to care earlier in their disease”.
The local doctors also pointed out that there were some shortcomings to the research, including obvious “limitations and uncertainty in extrapolating population level VL suppression from a public clinic database”.
The said, however, that “the projected estimate of 26 per cent national VL suppression is useful for comparing the barriers that exist between Barbados and the USA towards engagement of patients in care”.
“In the USA, notable challenges were reported in the retention of patients in care and in achieving VL suppression on ART, whereas in Barbados the biggest challenge was in linking HIV diagnosed individuals to care. Our data captures a proportion of private patients who are having VL determinations performed at the LRU laboratory,” they said.
“However, an estimated 2.6 per cent of the diagnosed HIV population — patients who may be seeking private care and private labs elsewhere — is not contained in our database, offering a partial explanation to the problem of linking diagnosed cases to care.”
The researchers said their study had made out a case “for a continued emphasis on destigmatising HIV, to engage patients in care at an earlier stage of their disease, and to maintain and promote universal access with state funding for HIV treatment including the provision of antiretroviral treatment”.
“Notwithstanding such challenges, the experience of Barbados should give hope to other Caribbean territories that VL suppression due to ART is an achievable goal. VL suppression at a population level may have played a role, in conjunction with other behavioral or structural interventions, in the decline of new cases from a peak in 2000 concurrent with introduction of antiretroviral treatment into Barbadian healthcare,” they added. (SC)