This publication provides high-level guidance on implementing and scaling up HIV viral load (VL) testing programmes for health ministries and implementation partners, using a three-phased approach: (1) planning; (2) scale-up; and (3) sustainability. The guidelines for managing antiretroviral therapy (ART) issued by the World Health Organization have recognized the importance of viral load monitoring since 2003. Routine VL monitoring is now strongly recommended as the monitoring strategy of choice.

In 2013, WHO recommended VL as the preferred monitoring approach to diagnose and confirm ART failure and using the reduced threshold of viral failure of 1000 copies/ml based on two consecutive VL measurements using plasma specimens within 12 months, with adherence support between measurements. There are many challenges to implementing VL monitoring in resource-limited settings, including complex technical requirements to perform the test, the logistics of specimen transport and cost. This publication addresses strategies to plan and implement a logical VL testing network, including engaging leadership, mapping and forecasting, product and specimen selection, algorithm development, human resources and infrastructure requirements, monitoring and evaluation (M&E), maintenance, quality management systems and training. A key inclusion is technical guidance on using dried blood spot (DBS) specimens. This publication is intended to serve as a reference point for countries, whether they are commencing implementation or scaling up existing VL testing capacity. Thoughtful consideration and planning of all areas covered in this publication will assist in developing a robust and sustainable HIV VL testing network.