This viral load (VL) scale up plan describes the current status of VL testing in Ghana, including a SWOT analysis; VL testing program targets and projections as well as program needs. Objectives and strategies addressed include program management, equipment, supply chain management, human resources, specimen referral and result transmission, quality assurance, laboratory information management, and monitoring and evaluation. The document provides a phased approach with a detailed workplan on how to address each of these areas. Viral load (VL) measurement is a critical tool to assess the impact of HIV treatment efforts, but though VL measurement is a laboratory assay, the challenge of VL scale-up is not for laboratorians only. Islamic Architecture 3d Models Free Download. The experience of early infant diagnosis (EID) scale-up highlights the importance of conceptualizing VL testing as a continuum; a series of steps, each critical for achieving the ultimate goal—swift and appropriate clinical management to maximize the chance of sustained viral suppression. This editorial describes the VL continuum and recommends that programs utilize viral suppression as the indicator of programmatic effectiveness.

To inform the scale-up of viral load testing, this commentary reviews the challenges and solutions from the large-scale implementation of other diagnostic tests including nucleic-acid based early infant HIV diagnosis (EID) and CD4 testing, and identifies key lessons. The lessons and innovations from large-scale EID and CD4 programs demonstrate the importance of an integrated approach to health system strengthening focusing on data systems, supply efficiencies, and network management as well as need for more innovative approaches and effective partnerships to achieve equitable and cost-effective test access. Viral load (VL) testing represents a substantial cost in resource-constrained health care systems. This systematic review identified 18 studies that evaluated the cost-effectiveness of VL monitoring in HIV treatment programs. The review identified three key factors that make it more likely for VL monitoring to be cost-effective: 1) Use of effective, lower-cost approaches to VL monitoring (e.g. Use of dried blood spots); 2) Ensuring the pathway to health improvement is established and that VL results are acted upon; and 3) VL results are used to simplify HIV care in patients with viral suppression (i.e. Differentiated care, with fewer clinic visits and longer prescriptions).