Lab Matters Summer 2018 - Page 18

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 PublicHealthLabs @APHL APHL.org