Abstract
BackgroundWith the largest antiretroviral therapy (ART) programme globally, demand for effective HIV management is increasing in South Africa. While viral load (VL) testing is conducted, VL follow-up and management are sub-optimal.ObjectivesThe objective of this study was to address gaps in the VL cascade to improve VL testing and management.MethodsAntiretroviral therapy records were sampled for an in-depth review. The study team then reviewed individual records, focusing on ART management, virological suppression and retention. Multifaceted interventions focused on virological control, including a clinical summary chart for ART care; streamlining laboratory results receipt and management; monitoring VL suppression, flagging virological failure and missed visits for follow-up; down-referral of stable patients eligible for the chronic club system; and training of personnel and patients.ResultsPre-intervention, 78% (94/120) of eligible patients had VL tests, versus 92% (145/158) post-intervention (p = 0.0009). Pre-intervention, 59% (71/120) of patients accessed their VL results, versus 86% (136/158) post-intervention (p < 0.0001). Post-intervention, 73% (19/26) of patients eligible for ART change were appropriately managed, versus 11% (4/36) pre-intervention (p < 0.0001). Only 27% had no regimen changes (7/26) post-intervention, versus 81% (29/36) pre-intervention (p < 0.0001).ConclusionService delivery was streamlined to facilitate HIV services by focusing on VL test monitoring, protocol training and accessibility of results, thereby improving clinical management.
Highlights
South Africa has the largest antiretroviral therapy (ART) programme in the world with over 4.1 million adults on treatment by the end of 2017.1 Despite expanded ART access, incident HIV infections are still substantial with approximately 270 000 individuals infected with HIV in 2017.1 In 2014, UNAIDS launched the 90–90–90 targets to progress towards elimination of HIV by 2020.2 The last ‘90’ of the UNAIDS strategy is to ensure that 90% of individuals receiving ART have achieved virologic suppression.[2]
26% of patients (54/206) were already on ART when transferred into the Primary Healthcare (PHC)
Viral load and retention in care review (Figure 1) Viral load testing and retention status were available for 87.1% (1339/1538) of patients
Summary
South Africa has the largest antiretroviral therapy (ART) programme in the world with over 4.1 million adults on treatment by the end of 2017.1 Despite expanded ART access, incident HIV infections are still substantial with approximately 270 000 individuals infected with HIV in 2017.1 In 2014, UNAIDS launched the 90–90–90 targets to progress towards elimination of HIV by 2020.2 The last ‘90’ of the UNAIDS strategy is to ensure that 90% of individuals receiving ART have achieved virologic suppression.[2]Plasma viral load (VL) is the main driver of new HIV infections.[3]. South Africa has the largest antiretroviral therapy (ART) programme in the world with over 4.1 million adults on treatment by the end of 2017.1 Despite expanded ART access, incident HIV infections are still substantial with approximately 270 000 individuals infected with HIV in 2017.1 In 2014, UNAIDS launched the 90–90–90 targets to progress towards elimination of HIV by 2020.2 The last ‘90’ of the UNAIDS strategy is to ensure that 90% of individuals receiving ART have achieved virologic suppression.[2]. In a study of South Africa’s ART ‘treatment cascade’ using data from the national health laboratory service (NHLS), almost half of all South Africans infected with HIV were not linked to care.[6] The authors were not able to report the proportion of diagnosed people who were not linked to care Among those linked to care and on treatment, only 73.7% had suppressed VLs. The overall http://www.sajhivmed.org.za. While viral load (VL) testing is conducted, VL follow-up and management are sub-optimal
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