{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:32:23Z","timestamp":1784683943484,"version":"3.55.0"},"reference-count":43,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Oxford\u2019s Research England QR Global Challenges Research Fund","award":["0007365"],"award-info":[{"award-number":["0007365"]}]},{"name":"Africa-Oxford Initiative","award":["AfiOx-119"],"award-info":[{"award-number":["AfiOx-119"]}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["216421\/Z\/19\/Z"],"award-info":[{"award-number":["216421\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,2,2]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Access to HIV viral load testing remains difficult for many people on antiretroviral therapy (ART) in low-income and middle-income countries. Weak laboratory and clinic systems often delay the detection and management of viraemia, which can lead to morbidity, drug resistance and HIV transmission. Point-of-care testing could overcome these challenges. We aim to assess whether it is feasible to conduct a randomised trial of point-of-care viral load testing to manage viraemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct an open-label, single-site, individually randomised, feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression, in Durban, South Africa. We will enrol approximately 100 people living with HIV who are aged \u226518 years, receiving first-line ART but with recent viraemia \u22651000 copies\/mL, and randomise them 1:1 to receive point-of-care viral load or standard laboratory viral load monitoring, after 12 weeks. All participants will continue to receive care from public sector healthcare workers following South African HIV management guidelines. Participants with persistent viraemia \u22651000 copies\/mL will be considered for switching to second-line ART. We will compare the proportion in each study arm who achieve the primary outcome of viral suppression &lt;50 copies\/mL at 24 weeks after enrolment. Additional outcomes include proportions retained in the study, proportions with HIV drug resistance, time to viral load results and time to switching to second-line ART. We will assess implementation of point-of-care viral load testing using process evaluation data, and through interviews and focus groups with healthcare workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>University of Oxford Tropical Research Ethics Committee and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal have approved the study. We will present results to stakeholders, and through conferences and open-access, peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>PACTR202001785886049.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-045373","type":"journal-article","created":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T03:34:32Z","timestamp":1613532872000},"page":"e045373","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6072-1430","authenticated-orcid":false,"given":"Jienchi","family":"Dorward","sequence":"first","affiliation":[{"name":"Nuffield 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Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fathima","family":"Sayed","sequence":"additional","affiliation":[{"name":"Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliot","family":"Bulo","sequence":"additional","affiliation":[{"name":"eThekwini Municipality Health Unit, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Moodley","sequence":"additional","affiliation":[{"name":"Department of Virology, University of KwaZulu-Natal, Durban, South Africa"},{"name":"National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Samsunder","sequence":"additional","affiliation":[{"name":"Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Lewis","sequence":"additional","affiliation":[{"name":"Centre for the Aids Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4470-1151","authenticated-orcid":false,"given":"Sarah","family":"Tonkin-Crine","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul K","family":"Drain","sequence":"additional","affiliation":[{"name":"Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA"},{"name":"Department 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