Returning HIV‐1 viral load results to participant‐selected health facilities in national Population‐based HIV Impact Assessment (PHIA) household surveys in three sub‐Saharan African Countries, 2015 to 2016

Abstract

IntroductionLogistical complexities of returning laboratory test results to participants have precluded most population‐based HIV surveys conducted in sub‐Saharan Africa from doing so. For HIV positive participants, this presents a missed opportunity for engagement into clinical care and improvement in health outcomes. The Population‐based HIV Impact Assessment (PHIA) surveys, which measure HIV incidence and the prevalence of viral load (VL) suppression in selected African countries, are returning VL results to health facilities specified by each HIV positive participant within eight weeks of collection. We describe the performance of the specimen and data management systems used to return VL results to PHIA participants in Zimbabwe, Malawi and Zambia.MethodsConsenting participants underwent home‐based counseling and HIV rapid testing as per national testing guidelines; all confirmed HIV positive participants had VL measured at a central laboratory on either the Roche CAP/CTM or Abbott m2000 platform. On a bi‐weekly basis, a dedicated data management team produced logs linking the VL test result with the participants’ contact information and preferred health facility; project staff sent test results confidentially via project drivers, national courier systems, or electronically through an adapted short message service (SMS). Participants who provided cell phone numbers received SMS or phone call alerts regarding availability of VL results.Results and discussionFrom 29,634 households across the three countries, 78,090 total participants 0 to 64 years in Zimbabwe and Malawi and 0 to 59 years in Zambia underwent blood draw and HIV testing. Of the 8391 total HIV positive participants identified, 8313 (99%) had VL tests performed and 8245 (99%) of these were returned to the selected health facilities. Of the 5979 VL results returned in Zimbabwe and Zambia, 85% were returned within the eight‐week goal with a median turnaround time of 48 days (IQR: 33 to 61). In Malawi, where exact return dates were unavailable all 2266 returnable results reached the health facilities by 11 weeks.ConclusionsThe first three PHIA surveys returned the vast majority of VL results to each HIV positive participant's preferred health facility within the eight‐week target. Even in the absence of national VL monitoring systems, a system to return VL results from a population‐based survey is feasible, but it requires developing laboratory and data management systems and dedicated staff. These are likely important requirements to strengthen return of results systems in routine clinical care.

Preliminary Acceptability of a Home-Based Peripheral Blood Collection Device for Viral Load Testing in the Context of Analytical Treatment Interruptions in HIV Cure Trials: Results from a Nationwide Survey in the United States

“…Our survey findings also highlight the challenges of computer access and digital literacy for accessing the results. In a resource-limited context, a recent study highlighted the feasibility of returning viral load test results to PWH, but this required developing the necessary laboratory and data management capacity and having dedicated staff [44].…”

Realizing the potential of routine viral load testing in sub‐Saharan Africa

“…discuss the optimal viral load threshold to use when defining virological failure , while Saito et al . describe the unique experience of providing viral load results to individuals participating in the PHIA Project . Specific issues related to viral load testing among pregnant women, infants and children, adolescents and selected key populations are described in articles by Lesosky et al .…”

“…Peter et al describe the lessons learned from scale-up of other laboratory tests, such as EID and CD4+ cell count assays, which can inform scale-up of viral load testing [23]. Ellman et al discuss the optimal viral load threshold to use when defining virological failure [24], while Saito et al describe the unique experience of providing viral load results to individuals participating in the PHIA Project [25]. Specific issues related to viral load testing among pregnant women, infants and children, adolescents and selected key populations are described in articles by Lesosky et al [26], Arpadi et al [27], Marcus et al [28] and Schwartz et al [29] respectively.…”

Quality and turnaround times of viral load monitoring under prevention of mother-to-child transmission of HIV Option B+ in six South African districts with a high antenatal HIV burden

“…Inefficient TATs in HIV care are still a common problem in other African settings. [11,12,[22][23][24][25][26][27] Although fewer facilities managed to achieve desirable TATs in the present study, the unbiased and shorter laboratory TATs are a promising outcome for SA. However, the fact that a largely rural district can achieve better overall outcomes than urban districts, and that merely having PoC technologies does not guarantee overall optimal TATs, reiterates the complexity of achieving optimal VL monitoring processes.…”

“…The reason is probably a combination of ill health-driven (or high VL) need to memorise one's VL, healthcare worker commitment, more recent collection of the VL result, service delivery culture or lack of quality improvement initiatives. [10][11][12] Recent ART initiation significantly reduced the odds of receiving expected care in two districts. The Option B+ policy follows a test-andtreat strategy, so this group is likely to have been diagnosed with HIV recently.…”