Towards virological monitoring of HIV-1 drug resistance in resource-limited settings

HIV-1 treatment monitoring is important to ensure effective viral suppression and prevent the development of HIV-1 drug resistance. Commercial assays for HIV-1 treatment monitoring are generally costly and complex, and require plasma as a sample type for testing. The components of this thesis are part of the Affordable Resistance Test for Africa (ARTA) project which aimed at developing more affordable HIV-1 treatment monitoring applications, including viral load monitoring and HIV-1 drug resistance genotyping, which can be universally applied in resource-limited settings (RLS). Key to application in RLS is the use of dried blood spot samples, which allow for easier sample collection, transport and storage in RLS compared to plasma. The described assays include a virological failure screening assay, and two HIV-1 drug resistance genotyping assays, one of which is specific to treatment failure in RLS. The described affordable HIV-1 treatment monitoring applications are designed specifically for universal application with all major HIV-1 subtypes, the greatest diversity of which are found in Africa. All applications are compatible with dried blood spot samples and have comparable sensitivities to commercially available alternatives. The use of these tests have been successfully demonstrated in Uganda and South Africa. The components of the ARTA project described in this thesis fit together in an algorithm that may be applicable for treatment monitoring of HIV-1 infected individuals in RLS. Additionally, they are ideal for use in surveillance and monitoring of HIV-1 drug resistance in RLS, which is vital for informed decision making for HIV-1 treatment programs in RLS.