Scaling up HIV viral load monitoring in Manicaland, Zimbabwe: challenges and opportunities from the field

Abstract

Background: Demand for viral load (VL) monitoring is expected to increase; however, implementation of the multifaceted VL testing poses numerous challenges. We report experiences from Médecins Sans Frontiéres (MSF) and partners in the scale-up of HIV VL in collaboration with the Ministry of Health and Child Care (MoHCC) of Zimbabwe.

Methods: A retrospective data review of routine reports from MSF-supported health facilities in Manicaland Province (Zimbabwe) was conducted. These secondary aggregate data were triangulated, and emerging themes of lessons learnt from VL monitoring were shared.

Results: A VL testing coverage of 63% (5966/9456) was achieved among the 40 health facilities, together with a switch rate to second-line antiretroviral therapy (ART) of 46.4% (108/233). The key enablers to scaling-up the VL monitoring were well-equipped and supported VL laboratories, the operationalisation of the on-the-job clinical mentoring and systematic weaning off of better performing health facilities. Concerted efforts from different implementing partners and funders in the HIV programme, and close collaboration with MoHCC were pivotal.

Conclusion: Our experience indicates that clinical mentoring is effective, and resulted in high VL testing coverage and up-skilling primary health care workers in VL monitoring. Attention must be focused on innovations for improving VL result utilisation, especially the identification and management of patients who fail ART.

Keywords: HIV treatment cascade; HIV viral load; VL monitoring scale-up; clinical mentoring; dried blood spot; low-resource settings; partner collaboration.

Conflict of interest statement

Conflicts of interest: none declared.

© 2019 The Union.

Figures

FIGURE 1

Phases in the MSF HF staff mentoring programme. VL = viral load; HF = health facility; MSF = Médecins Sans Frontières.

FIGURE 2

HIV VL cascade of the 10 selected sites in Manicaland Province. ART = antiretroviral therapy; VL = viral load; EAC = enhanced adherence counselling; HVL = high VL; HIV = human immunodeficiency virus.