Delays in repeat HIV viral load testing for those with elevated viral loads: A national perspective from South Africa

The World Health Organization recommends national programs use viral load monitoring for patients on ART1 to determine whether treatment has been successful and to guide clinicians on when to switch treatment to second-line regimens, indicated if the virus is resistant to first-line therapy. Not all countries are able to provide viral load testing as part of national programs but for
those that do, patients with an elevated viral load (VL) are recommended to undergo adherence counselling and then have a repeat measure within 3-6 months (Figure 1) to determine if treatment failure has occurred and the treatment regimen should be switched. In the absence of widespread resistance testing in low- and middle-income countries, patients who do not resuppress after adherence counselling are typically switched to second line treatment. While timely repeat testing is important to guide clinical care, the limited data that exists suggests that time to repeat viral load testing varies strongly by country and clinic and retesting is often delayed2,3. This can have negative consequences for patient morbidity, onward transmission, and the spread of resistant strains.