title: Scale-up of HIV Viral Load Monitoring--Seven Sub-Saharan African Countries.
abstract: To achieve global targets for universal treatment set forth by the Joint United Nations Programme on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (UNAIDS), viral load monitoring for HIV-infected persons receiving antiretroviral therapy (ART) must become the standard of care in low- and middle-income countries (LMIC) (1). CDC and other U.S. government agencies, as part of the President's Emergency Plan for AIDS Relief, are supporting multiple countries in sub-Saharan Africa to change from the use of CD4 cell counts for monitoring of clinical response to ART to the use of viral load monitoring, which is the standard of care in developed countries. Viral load monitoring is the preferred method for immunologic monitoring because it enables earlier and more accurate detection of treatment failure before immunologic decline. This report highlights the initial successes and challenges of viral load monitoring in seven countries that have chosen to scale up viral load testing as a national monitoring strategy for patients on ART in response to World Health Organization (WHO) recommendations. Countries initiating viral load scale-up in 2014 observed increases in coverage after scale-up, and countries initiating in 2015 are anticipating similar trends. However, in six of the seven countries, viral load testing coverage in 2015 remained below target levels. Inefficient specimen transport, need for training, delays in procurement and distribution, and limited financial resources to support scale-up hindered progress. Country commitment and effective partnerships are essential to address the financial, operational, technical, and policy challenges of the rising demand for viral load monitoring.
authors.forename: Shirley
authors.initials: S
authors.lastname: Lecher
authors.forename: Dennis
authors.initials: D
authors.lastname: Ellenberger
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kim
authors.forename: Peter N
authors.initials: PN
authors.lastname: Fonjungo
authors.forename: Simon
authors.initials: S
authors.lastname: Agolory
authors.forename: Marie Yolande
authors.initials: MY
authors.lastname: Borget
authors.forename: Laura
authors.initials: L
authors.lastname: Broyles
authors.forename: Sergio
authors.initials: S
authors.lastname: Carmona
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Chipungu
authors.forename: Kevin M
authors.initials: KM
authors.lastname: De Cock
authors.forename: Varough
authors.initials: V
authors.lastname: Deyde
authors.forename: Marie
authors.initials: M
authors.lastname: Downer
authors.forename: Sundeep
authors.initials: S
authors.lastname: Gupta
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Kaplan
authors.forename: Charles
authors.initials: C
authors.lastname: Kiyaga
authors.forename: Nancy
authors.initials: N
authors.lastname: Knight
authors.forename: William
authors.initials: W
authors.lastname: MacLeod
authors.forename: Boniface
authors.initials: B
authors.lastname: Makumbi
authors.forename: Hellen
authors.initials: H
authors.lastname: Muttai
authors.forename: Christina
authors.initials: C
authors.lastname: Mwangi
authors.forename: Jane W
authors.initials: JW
authors.lastname: Mwangi
authors.forename: Michael
authors.initials: M
authors.lastname: Mwasekaga
authors.forename: Lucy W
authors.initials: LW
authors.lastname: Ng'Ang'A
authors.forename: Yogan
authors.initials: Y
authors.lastname: Pillay
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Sarr
authors.forename: Souleymane
authors.initials: S
authors.lastname: Sawadogo
authors.forename: Daniel
authors.initials: D
authors.lastname: Singer
authors.forename: Wendy
authors.initials: W
authors.lastname: Stevens
authors.forename: Christiane Adje
authors.initials: CA
authors.lastname: Toure
authors.forename: John
authors.initials: J
authors.lastname: Nkengasong
mesh_terms: D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D011159:Population Surveillance; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents