key: cord-0753163-tw7vdo8c
authors: Lecher, Shirley Lee; Naluguza, Mary; Mwangi, Christina; N’tale, Jonathan; Edgil, Dianna; Alemnji, George; Alexander, Heather
title: Notes from the Field: Impact of the COVID-19 Response on Scale-Up of HIV Viral Load Testing — PEPFAR-Supported Countries, January–June 2020
date: 2021-05-28
journal: MMWR Morb Mortal Wkly Rep
DOI: 10.15585/mmwr.mm7021a3
sha: f50f3aa501ad049f75d5657950add61cfaf26ba5
doc_id: 753163
cord_uid: tw7vdo8c

nan

were examined. The period reviewed was September 2019-June 2020. PEPFAR-supported countries provide quarterly reported data on indicators that monitor the number of patients receiving ART, including viral load testing coverage (the number of ART patients with a documented viral load result within the past 12 months) and HIV viral suppression rates (the proportion of adult and pediatric patients who have been on ART for at least 3 months who have achieved viral suppression). These data were reviewed for viral load testing coverage of ART patients and rates of viral suppression since the COVID-19 pandemic began in March 2020. Data from Uganda are presented as an example.

Viral load testing coverage for all PEPFAR-supported countries was stable at 78% during September-December 2019. † However, viral load testing coverage decreased to 71% during January-March 2020, likely the result of limited access to clinical and laboratory services during the pandemic. After routine services were reinstated (April-June 2020), viral load testing coverage increased to 75%. Among ART patients who received viral load testing, the percentage who were virally suppressed remained stable at 91% during October 2019-March 2020, and at 92% during April-June 2020. This stability in viral load suppression suggests that, although fewer patients on ART were tested (as indicated by decreased viral load testing coverage rates), those who did receive a viral load test had access to ART and were compliant with their ART regimen.

Ugandan government authorities declared a national stay-athome order on April 1, 2020, in response to the COVID-19 pandemic (4). Viral load testing decreased during March-May 2020, with the largest decline occurring late in this period after the beginning of the COVID-19 pandemic (Figure) (5) . As the government eased restrictions, services were adapted to restore viral load testing. Specific government measures to mitigate the impact of COVID-19 included providing guidance on continuing essential services, increasing the number of viral load specimen pick-ups at testing facilities, expanding collection of dried blood spot specimens (which can be stored and transported without refrigeration) relative to plasma specimens, mobilizing the network of persons with HIV infection to serve as community volunteers to assist others with HIV infection, directly delivering ART to communities, and integrating viral load testing with ART distribution (4). This swift response helped restore viral load testing coverage to levels higher than those before the pandemic. † Data for PEPFAR countries were submitted by PEPFAR implementing partners to the U.S. Office of the Global AIDS Coordinator as part of routine program monitoring. The reporting range was July 1, 2019-June 30, 2020. During the COVID-19 pandemic, continuation of essential routine care of HIV patients and delivery of routine services will require innovative approaches to reduce the risk for COVID-19 among patients and health care workers. Implementing strategies to return viral load testing services to baseline, § such as clearing testing backlogs to increase the number of persons tested and sustaining services that provide adequate viral load testing to monitor ART patients for treatment success, can maintain HIV control. Access to viral load testing could be facilitated using point-of-care technology for special populations who need expedited testing, including pregnant and breastfeeding women, children with low viral suppression rates, and persons with presumptive ART failure, to prevent clinical deterioration. Despite the challenges of controlling the COVID-19 pandemic, PEPFAR-supported countries should continue advancing toward the 95-95-95 by 2030 goals with expansion of viral load testing for all persons with HIV infection who are receiving ART. Innovative approaches are needed to sustain the global progress made in recent years in response to the HIV epidemic. § After viral load testing ceased in some countries and decreased in others, specimen backlogs increased during interruption of services. A resumption of testing and return to baseline is necessary before an increase can occur. The 95% is a target to be reached by 2030 as countries continue to scale up HIV viral load testing, which just started in most sub-Saharan countries 2013-2014.

President's Emergency Plan for AIDS Relief. PEPFAR technical guidance in context of COVID-19

Fast track: ending the AIDS epidemic by 2030

The Global Fund, The Global Fund to Fight AIDS, Tuberculosis, and Malaria

Canada: GardaWorld Corporation, GardaWorld; 2020. Accessed

Uganda viral load: dashboard. Kampala, Uganda: Ministry of Health

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.