Observational studyBMC infectious diseases2023
Decentralization of viral load testing to improve HIV care and treatment cascade in rural Tanzania: observational study from the Kilombero and Ulanga Antiretroviral Cohort.
Observational study in BMC infectious diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The viral load monitoring cascade in HIV treatment programmes in sub-Saharan Africa: a systematic review.BMC public health · 2024Pooled it
- Timeliness of switching to second-line antiretroviral therapy following virologic failure in Dar es Salaam, Tanzania.BMC research notes · 2026Article
- Article
- Feasibility and acceptability of task sharing collection of HIV viral load dried blood spot samples with community lay cadres: A cross-sectional diagnostic validation study in Zimbabwe.PLOS global public health · 2026Article
- Impact of low-level viremia on HIV non-viral load suppression in low and middle-income countries.Annals of medicine and surgery (2012) · 2025Review
- Comparisons of Correlates of Viral Suppression Among Adults Living With HIV/AIDS in Tanzania: Analysis With and Without Including Survey Designs.AIDS research and treatment · 2025Article
- Understanding the impact of the COVID-19 pandemic on HIV/AIDS care and management in Tanzania: challenges, adaptations and lessons learnt-a review.BMJ public health · 2024Review
- Association between differentiated HIV care delivery model and low-level viremia among people living with HIV in Rwanda.AIDS research and therapy · 2024Article
- Virological Non-Suppression among Newly Diagnosed HIV-Positive Individuals on Dolutegravir-Based Antiretroviral Treatment in Eastern Ethiopia: Follow-Up Study.Tropical medicine and infectious disease · 2023Article
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Authors and funding
16 authors.
Funding
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Abstract
introductionMonitoring HIV viral load (HVL) in people living with HIV (PLHIV) on antiretroviral therapy (ART) is recommended by the World Health Organization. Implementation of HVL testing programs have been affected by logistic and organizational challenges. Here we describe the HVL monitoring cascade in a rural setting in Tanzania and compare turnaround times (TAT) between an on-site and a referral laboratory.
methodsIn a nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) we included PLHIV aged ≥ 15 years, on ART for ≥ 6 months after implementation of routine HVL monitoring in 2017. We assessed proportions of PLHIV with a blood sample taken for HVL, whose results came back, and who were virally suppressed (HVL < 1000 copies/mL) or unsuppressed (HVL ≥ 1000 copies/mL). We described the proportion of PLHIV with unsuppressed HVL and adequate measures taken as per national guidelines and outcomes among those with low-level viremia (LLV; 100-999 copies/mL). We compare TAT between on-site and referral laboratories by Wilcoxon rank sum tests.
resultsFrom 2017 to 2020, among 4,454 PLHIV, 4,238 (95%) had a blood sample taken and 4,177 (99%) of those had a result. Of those, 3,683 (88%) were virally suppressed. In the 494 (12%) unsuppressed PLHIV, 425 (86%) had a follow-up HVL (102 (24%) within 4 months and 158 (37%) had virologic failure. Of these, 103 (65%) were already on second-line ART and 32/55 (58%) switched from first- to second-line ART after a median of 7.7 months (IQR 4.7-12.7). In the 371 (9%) PLHIV with LLV, 327 (88%) had a follow-up HVL. Of these, 267 (82%) resuppressed to < 100 copies/ml, 41 (13%) had persistent LLV and 19 (6%) had unsuppressed HVL. The median TAT for return of HVL results was 21 days (IQR 13-39) at the on-site versus 59 days (IQR 27-99) at the referral laboratory (p < 0.001) with PLHIV receiving the HVL results after a median of 91 days (IQR 36-94; similar for both laboratories).
conclusionRobust HVL monitoring is achievable in remote resource-limited settings. More focus is needed on care models for PLHIV with high viral loads to timely address results from routine HVL monitoring.
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