HIV Viral Load Monitoring Among Patients Receiving Antiretroviral Therapy - Eight Sub-Saharan Africa Countries, 2013-2018

Abstract

One component of the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal to end the HIV/AIDS epidemic by 2030, is that 95% of all persons receiving antiretroviral therapy (ART) achieve viral suppression.^† Thus, testing all HIV-positive persons for viral load (number of copies of viral RNA per mL) is a global health priority (1). CDC and other U.S. government agencies, as part of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), together with other stakeholders, have provided technical assistance and supported the cost for multiple countries in sub-Saharan Africa to expand viral load testing as the preferred monitoring strategy for clinical response to ART. The individual and population-level benefits of ART are well understood (2). Persons receiving ART who achieve and sustain an undetectable viral load do not transmit HIV to their sex partners, thereby disrupting onward transmission (2,3). Viral load testing is a cost-effective and sustainable programmatic approach for monitoring treatment success, allowing reduced frequency of health care visits for patients who are virally suppressed (4). Viral load monitoring enables early and accurate detection of treatment failure before immunologic decline. This report describes progress on the scale-up of viral load testing in eight sub-Saharan African countries from 2013 to 2018 and examines the trajectory of improvement with viral load testing scale-up that has paralleled government commitments, sustained technical assistance, and financial resources from international donors. Viral load testing in low- and middle-income countries enables monitoring of viral load suppression at the individual and population level, which is necessary to achieve global epidemic control. Although there has been substantial achievement in improving viral load coverage for all patients receiving ART, continued engagement is needed to reach global targets.

FIGURE 1

Percentage of HIV-positive patients receiving antiretroviral therapy who had ≥1 viral load test before and after scale-up of viral load testing — six sub-Saharan African countries, 2013–2014 and 2018 Abbreviations: ART = antiretroviral therapy; VL = viral load. * Two countries not shown (South Africa and Tanzania) because data were only provided through June 2018. ^† Period before scale-up was 2014 in Côte d’Ivoire and 2013 in all other countries.

FIGURE 2

Percentage of HIV viral load tests indicating viral suppression before and after viral load testing scale-up — eight sub-Saharan African countries, 2013–2014 and 2018 * Viral suppression is <1,000 copies of HIV RNA per mL of blood. ^† Two countries not shown (South Africa and Tanzania) because data were only provided through June 2018. ^§ Period before scale-up was 2014 in Côte d’Ivoire and 2013 in all other countries.