The African Society for Laboratory Medicine (ASLM) participated in a two-day meeting to review the state of HIV viral load testing and early infant diagnosis in Ethiopia. The meeting took place in Addis Ababa from 14 July to 15 July 2017 and was attended by representatives from across Ethiopia. The workshop brought together over 65 participants from 11 regions, including representatives from the Ethiopian Federal Ministry of Health, ICAP Columbia University, the Centers for Disease Control and Prevention Ethiopia, the Clinton Health Access Initiative and ASLM.

In response to the challenge of achieving the third 90 of the UNAIDS 90-90-90 targets (90% of patients on antiretroviral therapy are virally suppressed) [1], the Ethiopian Ministry of Health implemented a high quality viral load monitoring program in Ethiopia. A campaign to raise awareness about viral load testing was launched by the Ministry of Health in January 2016, followed by the implementation of routine viral load testing for patients receiving antiretroviral therapy in March 2016.

At the meeting, representatives from the Ethiopian Public Health Institute reported that there are currently 18 laboratories that provide viral load testing in Ethiopia.  A total of 128,615 viral load tests were performed from October 2016 to March 2017, achieving 48.8% coverage of patients receiving antiretroviral therapy. Viral load suppression was reported in 73% of pediatric patients and 83.9% of adult patients.

Dr. Aytenew Ashenafi, Program Manager for laboratory systems at ASLM, emphasized the need to strengthen monitoring and evaluation systems to track the progress of viral load testing scale-up in Ethiopia. In addition, he encouraged the wide use of standardized tools, such as the viral load scorecard [2], to support the identification and improvement of weaknesses of the laboratory-clinic interface and enhance the correct utilization of viral load results for clinical management.

Meeting participants acknowledged that challenges remain for Ethiopia in achieving the third 90 of the UNAIDS 90-90-90 targets. An important take-home message was the need to further increase awareness for routine viral load testing among clinicians and patients, and address various laboratory system weaknesses, such as reducing test turn-around times, improving the coverage of sample referral systems, ensuring the maintenance of laboratory equipment and adequate viral load testing supplies. To achieve these goals, meeting participants developed an action plan for improvement of HIV viral load scale-up in Ethiopia.

“Ethiopia has made great progress to date,” said Dr. Pascale Ondoa, ASLM’s Director of Science. “The strong regional leadership demonstrated at the recent meeting and the solid action plan will ensure that the country will continue on the path towards achieving the third 90.”

By: Dr. Aytenew Ashenafi, ASLM; Editors: Dr. Pascale Ondoa, ASLM; Ms. Bethanie Rammer, ASLM

Resources:

[1] UNAIDS 90-90-90. http://www.unaids.org/en/resources/909090

[2] World Health Organization, ASLM, Centers for Disease Control and Prevention, United States Agency for International Development, Clinton Health Access Initiative, Médecins Sans Frontières, Global Fund, Riders for Health, Clinical Laboratory Standards Institute. Viral load scorecard. http://www.aslm.org/resource-centre/hiv-viral-load-testing/hiv-viral-load-scale-tools/