Routine plasma viral load (VL) testing is the WHO-recommended method for monitoring HIV-infected patients on antiretroviral therapy (ART). In Zambia, VL scale-up is limited due to significant logistical obstacles around plasma specimen collection, storage, and transport to centralized laboratories. Dried blood spot (DBS) technology could circumvent many logistical challenges at the cost of reduced sensitivity and/or specificity. Recently, plasma separation cards (PSC) have become available and, though more expensive, have lower total misclassification than DBS. Adopting the partial use of dried specimens will help achieve improved VL access for patients at the lowest cost/correct result.