Introduction HIV viral load (VL) testing in resource-limited settings is often centralised, limiting access. In Myanmar, we assessed outcomes according to VL access and the VL cascade (case management after a first high VL result) before and after near point-of-care (POC) VL was introduced. Methods Routine programme data from people living with HIV (PLHIV) on antiretroviral therapy (ART) were used. We assessed the odds of getting a VL test done by year. Attrition and mortality two years after ART initiation were compared between three groups of PLHIV with different access to VL testing using Kaplan-Meier analysis. We compared VL cascades in those with a first VL result before and after near POC VL testing became available. With logistic regression, predictors of confirmed virological failure after a first high VL in the POC era were explored. Results Among 4291 PLHIV who started ART between July 2009 and June 2018, 794 (18.5%) became eligible for VL testing when it was not available, 2388 (55.7%) when centralised laboratory-based VL testing was available, and 1109 (25.8%) when near POC VL testing was available. Between 2010 and 2019, the odds of getting a VL test among those eligible increased with each year (OR: 5.21 [95% CI: 4.95–5.48]). Attrition and mortality were not different in the three groups. When comparing PLHIV with a first VL result before and after implementation of the near POC VL testing, in the latter, more had a first VL test (92% versus 15%, p<0.001), less had a first high VL result (5% versus 14%, p<0.001), and more had confirmed virological failure (67% versus 47%, p = 0.013). Having a first VL ≥5000 copies/mL after near POC implementation was associated with confirmed virological failure (adjusted OR: 2.61 [95% CI: 1.02–6.65]). Conclusion Near POC VL testing enabled rapid increase of VL coverage and a well-managed VL cascade in Myanmar.

Introduction: HIV viral load testing in resource-limited settings is often centralized, limiting access. Near point-of-care (POC) viral load testing was introduced in Myanmar in 2017. We assessed its uptake and utilization. Methods :  Routine program data from three HIV clinics of Medical Action Myanmar were used. Annual viral load uptake was cross-sectionally analysed in people living with HIV (PLHIV) on antiretroviral therapy (ART) initiated between July 2009-June 2019. Attrition at two years was assessed between PLHIV with different access to viral load testing with Kaplan-Meier analysis. For those eligible for a first viral load when near POC viral load became available, a viral load cascade was constructed. We used logistic regression to explore predictors of confirmed virological failure after a first high viral load. Results: Among 5271 PLHIV who started ART between July 2009-December 2019, annual viral load uptake increased significantly after near POC was introduced. Attrition in the first two years after ART initiation was not different among those eligible for a first viral load before viral load was available, after centralized laboratory-based viral load, and after near POC viral load introduction. After introduction of near POC viral load, 92% (2945/3205) of eligible PLHIV received a first viral load, a median of 2.8 years (IQR: 1.4-4.4) after initiation. The delay was 3.7 years (IQR: 2.8-5.1) and 0.9 years (IQR: 0.6-1.4) in those becoming eligible before and after near POC viral load was available, respectively. Among those with a first viral load, 95% (2796/2945) were <=1000 copies/ml. Eighty-four % (125/149) of those with a viral load >1000 copies/ml received enhanced adherence counselling and a follow up viral load, a median of 119 days (IQR: 95-167) after the first viral load. Virological failure was confirmed in 67% (84/125), and 82% (69/84) of them were switched to second-line ART. Nine-three % (64/69) among those switched were alive on ART at end of follow-up. Having a first viral load of >=5000 copies/ml was associated with confirmed virological failure. Conclusion: Near POC viral load testing enabled rapid scale-up of viral load testing in Myanmar. PLHIV with a high viral load were adequately managed.