APHL is helping Zimbabwe to transition from CD4 to viral load (VL) testing as the routine method for assessing the treatment status of HIV/AIDS patients on antiretroviral therapy. The World Health Organization has recommended VL over CD4 testing because it detects treatment failure more rapidly and accurately than CD4 tests.
In collaboration with the Zimbabwe Ministry of Health and Child Care, APHL has increased laboratory capacity to perform VL testing and made it available in more places. Among other activities, it has furnished equipment for specimen processing, developed quality management systems, certified laboratory scientists and collaborated with Ministry partners to generate demand for VL testing.
Prior to the VL scale-up in 2016, only 3% of laboratories in Zimbabwe performed VL testing. They monitored patients' CD4 counts and performed limited VL testing when counts fell or remained low, or when the patient's condition did not improve with treatment. Local testing facilities lacked the resources to implement VL testing for all patients on antiretroviral therapy.
Yet only one year after the scale-up launch, VL testing coverage rose from 3% to 46%, and over 95% of clinics in districts with the highest concentration of HIV patients had access to routine VL testing. By the end of 2017, Zimbabwe had surpassed its routine VL testing target of 40% of the patient population.
Strategies contributing to these impressive metrics include implementation of point-of-care VL testing; changing from whole blood to more stable plasma for VL and dried blood specimens used for early infant diagnosis; and strengthening the specimen referral network and transport system.
Zimbabwe's viral load scale-up is funded through PEPFAR in support of the UNAIDS 90-90-90 goals. For more information, contact Lucy Maryogo-Robinson, director, Global Health, firstname.lastname@example.org.