WHO/PEPFAR/USAID Developing A Monitoring And Evaluation Framework For Viral Load Testing

November 15, 2018

The 2013 WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection recommend viral load as the preferred monitoring approach to diagnose and confirm ART failure. As countries invest in the scale-up of routine viral load testing, it is critical to measure the impact and progress towards achieving the UNAIDS target of 90% viral suppression amongst patients on ART by 2020. This document presents key considerations and examples of tools (provided in the appendices) to assist countries in developing a national viral load (VL) monitoring and evaluation (M&E) plan.

Section 1 describes the process of assessing M&E data systems and tools and understanding how data flows to and from facilities, sample transport networks and laboratories. Stakeholders from lab, HIV care and treatment, and M&E need to review and update systems and tools to adequately capture and utilize data at site, district and national levels of their program. Section 2 outlines a set of indicators that M&E systems are encouraged to collect in order to measure key program and patient outcomes along the VL testing cascade.

Section 2 also includes a discussion on how to monitor patients who are not virally suppressed and suggests tools for longitudinally following cohorts of non-suppressed
patients. Appendix 3 includes examples of data collection tools that country programs can adapt for their setting and Appendix 5 includes a menu of possible indicators that can be integrated into an M&E Framework or plan for VL. Section 3 provides methods for evaluating viral load implementation plans and examples of evaluation questions.