title: Improving laboratory efficiencies to scale-up HIV viral load testing.
abstract: Viral load measurement is a key indicator that determines patients' response to treatment and risk for disease progression. Efforts are ongoing in different countries to scale-up access to viral load testing to meet the Joint United Nations Programme on HIV and AIDS target of achieving 90% viral suppression among HIV-infected patients receiving antiretroviral therapy. However, the impact of these initiatives may be challenged by increased inefficiencies along the viral load testing spectrum. This will translate to increased costs and ineffectiveness of scale-up approaches. This review describes different parameters that could be addressed across the viral load testing spectrum aimed at improving efficiencies and utilizing test results for patient management.
  
  
  
  Though progress is being made in some countries to scale-up viral load, many others still face numerous challenges that may affect scale-up efficiencies: weak demand creation, ineffective supply chain management systems; poor specimen referral systems; inadequate data and quality management systems; and weak laboratory-clinical interface leading to diminished uptake of test results.
  
  
  
  In scaling up access to viral load testing, there should be a renewed focus to address efficiencies across the entire spectrum, including factors related to access, uptake, and impact of test results.
authors.affiliation: aDivision of Global HIV and Tuberculosis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia bState Department Office of the Global AIDS Coordinator and Health Diplomacy (S/GAC), Washington, D. C., USA cWorld Health Organization, Regional Office for Africa, Intercountry Support Team for East and Southern Africa, Harare, Zimbabwe.
authors.forename: George
authors.initials: G
authors.lastname: Alemnji
authors.forename: Philip
authors.initials: P
authors.lastname: Onyebujoh
authors.forename: John N
authors.initials: JN
authors.lastname: Nkengasong
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D064790:Clinical Laboratory Services / Q000458:organization & administration*; D019468:Disease Management; D016903:Drug Monitoring / Q000379:methods / Q000706:statistics & numerical data*; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D019562:Viral Load / Q000379:methods / Q000706:statistics & numerical data*
chemical_list: D019380:Anti-HIV Agents