HIV viral load testing coverage and timeliness after implementation of the wellness anniversary in a paediatric and adolescent HIV clinic in KwaZulu-Natal, South Africa.

Sibusiso E Kubheka,Kevindra K Naidu,Moherndran Archary

doi:10.4102/sajhivmed.v21i1.1016

Sibusiso E Kubheka, Kevindra K Naidu + Show 1 more

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https://doi.org/10.4102/sajhivmed.v21i1.1016

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Abstract

BackgroundThe UNAIDS 2020 Global strategy to reduce the transmission of HIV includes ensuring HIV viral load (VL) testing coverage of at least 90% on all patients on antiretroviral therapy (ART). Routine VL monitoring has been shown to result in earlier detection of treatment failure, timely regimen switches, promotion of adherence to treatment and improved survival. We wanted to assess the introduction of the wellness anniversary in improving routine viral load monitoring.ObjectivesWe retrospectively assessed effects of the wellness anniversary on routine VL coverage, timeliness and suppression rates.MethodThe month when the patient initiated ART was designated as the wellness anniversary. On the anniversary month a package of care, which included a routine VL, was delivered. We conducted a retrospective chart audit to assess VL coverage and timeliness between two time periods, from January 2016 to December 2016 (pre-implementation) and from January 2017 to December 2017 (post-implementation).ResultsTimeliness of VL testing improved from 27.5% in the pre-implementation cohort to 49.7% in the post-implementation cohort. Our study showed high VL testing coverage before the implementation of the wellness anniversary with an average of 98.3% VL. There was a significant correlation between timeliness and VL suppression (VLS) in the post-implementation group.ConclusionImplementation of the wellness anniversary may improve timeliness of routine VL testing in settings with high VL coverage. Studies looking at the effect of timeliness on VLS and clinical outcomes are needed.

Highlights

South Africa has the largest HIV epidemic in the world, with about 7.2 million people living with HIV in 2017.1 According to the 2016 UNAIDS report, about 320 000 children below 15 years were living with HIV in South Africa in 2016.2 While about 90% of people in South Africa living with HIV knew their status, only 59% of children living with HIV in South Africa had access to antiretroviral therapy (ART)
The UNAIDS 2020 Global strategy to reduce the transmission of HIV includes ensuring HIV viral load (VL) testing coverage of at least 90% on all patients on ART.[3]
Factors that were found to contribute to low HIV VL testing coverage in lowand middle-income countries (LMIC) included poor adherence to World Health Organization (WHO) guidelines, low levels of http://www.sajhivmed.org.za

Summary

Introduction

South Africa has the largest HIV epidemic in the world, with about 7.2 million people living with HIV in 2017.1 According to the 2016 UNAIDS report, about 320 000 children below 15 years were living with HIV in South Africa in 2016.2 While about 90% of people in South Africa living with HIV knew their status, only 59% of children living with HIV in South Africa had access to antiretroviral therapy (ART). The UNAIDS 2020 Global strategy to reduce the transmission of HIV includes ensuring HIV viral load (VL) testing coverage of at least 90% on all patients on ART.[3] Routine HIV VL monitoring has been shown to improve earlier detection of treatment failure, timely regimen switches, promoting adherence to treatment and survival.[4] the effect of timeliness of routine VL monitoring on the positive effects of routine VL monitoring is unknown. The UNAIDS 2020 Global strategy to reduce the transmission of HIV includes ensuring HIV viral load (VL) testing coverage of at least 90% on all patients on antiretroviral therapy (ART). We wanted to assess the introduction of the wellness anniversary in improving routine viral load monitoring

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