Abstract
ObjectivesKenya is one of the first African countries to scale up a national HIV viral load monitoring program. We sought to assess program scale up using the national database and identify areas for systems strengthening.MethodsData from January 2012 to March 2016 were extracted from Kenya’s national viral load database. Characteristics of 1,108,356 tests were assessed over time, including reason for testing, turnaround times, test results, treatment regimens, and socio-demographic information.ResultsThe number of facilities offering viral load testing increased to ~2,000 with >40,000 tests being conducted per month by 2016. By March 2016, most (84.2%) tests were conducted for routine monitoring purposes and the turnaround time from facility-level sample collection to result dispatch from the lab was 21(24) [median (IQR)] days. Although the proportions of repeat viral load tests increased over time, the volumes were lower than expected. Elevated viral load was much more common in pediatric and adolescent patients (0-<3 years: 43.1%, 3-<10 years: 34.5%, 10-<20 years: 36.6%) than in adults (30-<60 years: 13.3%; p<0.001).ConclusionsCoverage of viral load testing dramatically increased in Kenya to >50% of patients on antiretroviral therapy (ART) by early 2016 and represents a relatively efficient laboratory system. However, strengthening of patient tracking mechanisms and viral load result utilization may be necessary to further improve the system. Additional focus is needed on paediatric/adolescent patients to improve viral suppression in these groups. Kenya’s national viral load database has demonstrated its usefulness in assessing laboratory programs, tracking trends in patient characteristics, monitoring scale-up of new policies and programs, and identifying problem areas for further investigation.
Highlights
National HIV programs in resource-limited settings historically have used CD4 cell count, a marker of immune status, to monitor patient response to HIV antiretroviral therapy (ART)
The number of facilities offering viral load testing increased to ~2,000 with >40,000 tests being conducted per month by 2016
Coverage of viral load testing dramatically increased in Kenya to >50% of patients on antiretroviral therapy (ART) by early 2016 and represents a relatively efficient laboratory system
Summary
National HIV programs in resource-limited settings historically have used CD4 cell count, a marker of immune status, to monitor patient response to HIV antiretroviral therapy (ART). VL testing, which has been widely available in high-income countries for many years, is used to assess viral response to therapy and identify patients who may be failing treatment. VL testing has traditionally been relatively expensive and required intensive infrastructure and human resources, creating barriers to scale-up. Despite these challenges and concerns about feasibility in resource-limited settings,[1] a national VL program was first established in Kenya in 2012 with growth over subsequent years. VL testing was prioritized for patients with suspected virologic failure, but starting in 2014 Kenyan guidelines recommended routine testing, defined as a VL test 6 months and 12 months after ART initiation and annually thereafter, for patients with undetectable viral loads. Patients with elevated VL (defined as !1000 copies/mL) should receive follow-up per national guideline algorithms.[4]
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