Technical And Operational Considerations For Implementing HIV Viral Load Testing
November 15, 2018
This publication provides high-level guidance on implementing and scaling up HIV viral load 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 WHO have recognized the importance of viral load monitoring since 2003. Routine viral load monitoring is now strongly recommended as the monitoring strategy of choice.
In 2013, WHO recommended viral load 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 viral load measurements using plasma specimens within 12 months, with adherence support between measurements. There are many challenges to implementing viral load 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 viral load testing network, including engaging leadership, mapping and forecasting, product and specimen selection, algorithm development, human resources and infrastructure requirements, monitoring and evaluation, maintenance, quality management systems and training. A key inclusion is technical guidance on using dried blood spot specimens. This publication is intended to serve as a reference point for countries, whether they are commencing implementation or scaling up existing viral load testing capacity. Thoughtful consideration and planning of all areas covered in this publication will assist in developing a robust and sustainable HIV viral load testing network.