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Hi I am a frequent reader, but don't often post to this community. I am a doctoral student at present with 20 years of past nursing experience in HIV. I have a question about HIV viral load testing - if one were to open the chart of a person on ART in a typical health center or clinic in southern or eastern Africa - how frequently within a calendar year would viral load testing be done ( and even if done would the results actually be noted in the chart?) Considering the new WHO guidelines, what countries are already doing viral load load rather than cd4 testing to monitor treatment?

Mohammed suaudi Hassen
Replied at 4:21 AM, 17 Jul 2013

i am need to know the way.

Yaa Obeng-Aduasare
Replied at 9:36 AM, 17 Jul 2013

Hi Elizabeth,

At my ART clinic in Northern Namibia, VL testing was done semi-annually.

Elizabeth Glaser
Replied at 1:51 PM, 17 Jul 2013

Dear Yaa
Thanks- I see you worked in the peace corp - was this a typical government clinic?
Was it your impression that this was done within 3 months after initiation and then twice a year there after ?


Yaa Obeng-Aduasare
Replied at 2:44 PM, 17 Jul 2013

It was typical in the size of its catchment area , however there were a lot
more resources because this specific clinic was funded entirely by USAID.
It is was rare for VL to be taken within the first 3 months after HAART
initiation, the first VL was done 6months after initiation. Baseline
clinical tests did not include viral load.


"Remember to keep your words soft and sweet for you never know when you
have to eat them." - Zulu Proverb

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Zulu women's mantra

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singing its virtues." Ngugi wa Thiong'o on the African's infatuation with
the coloniser's language


Kenly Sikwese
Replied at 1:41 AM, 18 Jul 2013

In most African countries. routine VL monitoring is not offered except when assessing treatment failure. Even then, it's usually done late. People with HIV can access VL tests from privaye laboratories at an exorbitant cost. Ideas have been floated to offer bi-anual community VL monitoring to reduce costs. If point of care units can reduce costs to the same level as current CD4 tests, this has potential to accelerated transition to VL monitoring in line with the 2013 guideline recommendations

John Spurrier
Replied at 1:30 PM, 18 Jul 2013

I work in Zambia at a hospital with a large ART clinic. Routine viral load testing is not done here. It is only done when treatment failure is suspected. It is expensive and a frozen sample needs to be transported to Lusaka. At the last national update the Ministry of Health representative talked about hoping more viral load testing could be done in the near future.

Thomas Heller
Replied at 11:00 AM, 12 Aug 2013

The answer in Ethiopia is zero. Viral load testing is available but way
underutilized, in part because plasma must be transported by cold chain,
and there is no transport system, so it either falls to a health facility
staff person or the patient him/herself to travel to the regional
laboratory, which can be a day's trip away. Ethiopia is validating dried
blood spot for viral load testing, which could be transported by the
national postal service; while it has been validated in other countries,
Ethiopia insists on doing its own evaluation, and the study appears to have
been mired in methodologic sloppiness--so for now we're at a stalemate. My
own hope is to work with the Ethiopia Health and Nutrition Research
Institute, where the study was conducted to review the study and facilitate
implementation of viral load by dried blood spot so that a viral load
guideline for routine monitoring can be implemented. I will be interested
in other responses you receive. My work e-mail address is

Shubhada Hooli
Replied at 11:53 AM, 12 Aug 2013

In Malawi the MOH in partnership with CHAI just introduced VL testing this
June. It is only really available in Lilongwe and Blantyre - the two
largest cities where in total about 15% of the population reside.

My work there was with Baylor College of Medicine in pediatric HIV. We
used the following guidelines to determine when a patient should have their
VL checked:
-on first line w suspected clinical failure
-less than 24 months old with previous exposure to NVP (NVP is part of our
1st line regimen)
-h/o falling CD4 x 2 (on most patients we check CD4 annually unless it is
borderline then every 6 mo)
-no VL check in past 2 yrs
-3 mo after initiation of 1st line with at least 3 months of continuous

Asfawesen Gebreyohannes Woldegiorgis
Replied at 1:39 AM, 13 Aug 2013

Thank you Thomas for telling us the current situation in Ethiopia. It is realy frustrating and at the same time disapponiting that as a country we are totally unfortunate in having a credible national laboratory managment system. VL should have been available in all tertiary hospitals and not limited to only in Regional Lab the quality of which unsubstantiated. We are suffering too much and beyond tolerance in intoruducing new diagnostic technologies like GenXpert for similar reason of national validation study. I think FMoH should improve its assymmetrical thinking and start to work on improving the hospital and laboratory services in the country. Lab service needs new managment system with clinical and public health orientation.

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