This paper by Jilian Sacks et al, 2019, presents a meta-analysis of studies comparing the Cepheid Xpert HIV-1 viral load (VL) plasma assay to traditional laboratory-based technologies. Cepheid Xpert HIV-1 VL plasma assay results were highly comparable to laboratory-based technologies with limited bias and high sensitivity and specificity to detect treatment failure. Alternative specimen types and technologies that enable decentralized testing services can be key to supporting VL scale-up and improving coverage of VL testing.