AIDS 2016 ASLM Satellite Session: Scaling-up Access to HIV Viral Load Testing – 20 July 2016

Co-chaired by Gottfried Hirnschall, World Health Organization, Switzerland and Shannon Hader, United States Centers for Disease Control and Prevention

Highlights:

  • In four country presentations, Ministries of Health discussed successes and lessons learned from the scale-up of HIV viral load testing in their particular contexts:
    • Botswana’s decentralized testing model provided an example of how “taking the services closer to the people, rather than people coming to the services” can increase access, when supported by strong partnerships.
    • Kenya emphasized the importance of physician engagement to ensure that HIV viral load results are used in clinical decision-making and the critical role of data in managing a rapidly growing testing program.
    • Malawi shared their solutions for building sample transportation networks, improving supply-chain management, and increasing human resources capacity, while more than doubling HIV viral load testing volumes.
    • Uganda presented on how they used a centralized model, developing a single laboratory capable of processing over 1.2M samples per year. The program has maintained a turnaround time of under two weeks, while increasing the number samples processed by more than 200,000 in a year’s time.
  • World Health Organization shared key recommendations from the 2016 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection, including that:
    • dried blood spot specimens using venous or capillary whole blood can be used to determine HIV viral load and using a failure threshold of 1,000 copies/ml.
    • viral load testing should be measured at 6-months, 12-months, and then every 12-months after ART initiation.
  • A presentation from United States Centers for Disease Control and Prevention, emphasized the importance of a collaborative approach to HIV viral load scale-up, including physician engagement, patient education, and demand creation. Realization of improved efficiency will be critical to supporting increasing testing volumes in the coming years.
  • Médecins Sans Frontières International provided several recommendations from their experience providing HIV viral load services, particularly around access to 2nd line treatment, including the importance of decentralization of second line drug availability, task shifting, remote switch decision support apps, sending case summaries to district level, and managing perceptions of second line drugs from HCW and clients.