global health
Increasing Viral Load Testing in Zimbabwe
from 3% to 46% in a Year
by Levi Vére, manager, laboratory quality monitoring, Global Health and Victoria Ndarukwa, laboratory mentor, Global Health
In early 2016, Zimbabwe adopted the
World Health Organization’s “treat-all”
recommendation, which resulted in a
transition from CD4 to viral load (VL)
testing as the routine monitoring method
for assessing the treatment status of HIV/
AIDS patients on antiretroviral therapy.
VL testing detects treatment failure more
rapidly and accurately than CD4 tests.
APHL has provided scale-up support for
this transition, addressing needs along the
entire VL testing cascade—pre-analytical,
analytical and post-analytical phases—to
increase laboratory capacity to perform
VL testing and make it available in more
places (See sidebar).
Previously, only 3% of the approximately
1,300,000 Zimbabweans living with HIV/
AIDS had access to Viral Load testing.
Routine monitoring was conducted by
measuring patients’ CD4 counts, with
limited VL testing performed in a targeted
manner when counts remained low or fell
or the clinical condition of the patient did
not improve even after commencement of
treatment. Local testing facilities lacked
the resources to implement VL testing for
all patients on antiretroviral therapy, cre-
ating an imbalance in quality and access
to care.
The centralization of Zimbabwe’s VL
testing laboratories, with each lab
serving one or more provinces, made it
essential to increase access to VL testing
for populations far from provincial VL
testing laboratories. Strategies included
using dried blood spot (DBS) specimens,
which are more stable than whole blood
samples, implementing point-of-care VL
tests, and improving the specimen referral
network and transport system.
Table 1 and Figure 1 show that patient
VL testing coverage rose sharply from
3% to 46% within a year of APHL and
MOHCC implementing VL scale-up
activities. Additionally, over 95% of clinics
in PEPFAR-supported districts* were able
16
LAB MATTERS Summer 2018
Figure 1: VL test scale-up
Indicator Before After
Test coverage 3% 46%
Referral network coverage
(PEPFAR districts) No access to routine VL testing 95%
Lab turnaround time >42 days 6 days
Average QMS SLIPTA scores 54% (0 stars) 82% (3 stars)
VL EQA No EQA 100% pass rate in last round
Table 1: VL-scale up indicators showing improvement in access and quality.
to access routine VL testing through
the expansion of the specimen referral
network by the end of the first year.
* Approximately 80% of people living with
HIV in Zimbabwe reside in these PEPFAR-
supported districts.
APHL’s assistance enabled Zimbabwe to
surpass its routine VL testing coverage
target of 40% by the end of 2017, thus
increasing equitable access to healthcare
for all Zimbabweans. n
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