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CD4 and viral load testing have the potential to improve patient treatment and enhance patient demand. Yet, in reality, only a portion of the test results are used for patient management. Given the cost, promise, but unrealized potential of these diagnostics, what is the case for their future use? While CD4 is no longer required to determine eligibility for ART, many advocates are passionate about its importance for identifying patients at risk of advanced disease and providing them with appropriate services. Viral load testing may no longer be necessary to determine second line eligibility if tenofovir-lamivudine-dolutegravir is implemented for both first and second line ART. Yet the “Undetectable=Untransmittable” campaign has great potential as a means of improving patient demand and adherence to treatment. This session will examine the promise of CD4 and VL testing, reveal the realities of implementation, and provoke a debate on the best path forward.

07:00
Framing remarks: adapting diagnostic strategies to the era of Test and Treat and the potential scale up of dolutegravir regimens
Peter Ehrenkranz, Bill & Melinda Gates Foundation, United States
07:05
The promise and history of CD4 use and scale up for patient management and surveillance
Lara Vojnov, World Health Organization, Switzerland
07:13
The promise and history of viral load use and scale up for patient management and surveillance
Naoko Doi, Clinton Health Access Initiative, United States
07:21
The reality: The Malawi experience of utilizing CD4 and VL test results to change practice, the opportunity cost of unused results, and attempts to improve utilization
Michael Odo, Department of HIV/AIDS, Malawi Ministry of Health/I-TECH, Malawi
07:29
Debating the future: Should we continue to scale up and try to improve utilization of VL and of CD4 in the era of Treat All, U=U, and (potentially) TLD?
Tom Ellman, Medecins Sans Frontieres, South Africa
Elliot Raizes, US Centers for Disease Control and Prevention, United States
Charles Holmes, Georgetown University, United States
07:49
Community response and perspectives on CD4 and VL demand, use and scale-up
Solange Baptiste, International Treatment Preparedness Coalition, South Africa
07:57
Open forum with panelists responding to live electronic question asking/voting from the audience
08:17
Closing remarks
Pascale Ondoa, African Society of Laboratory Medicine, Ethiopia