Blood samples are taken from patients at a government health facility in Busia district in East Central Uganda

Wilbur, a 38-year-old husband and father of six children in Makada Village, received an unexpected phone call one day. A health worker at the Buyinja Health Center IV said Wilbur – who has HIV – was due to have a viral load (VL) test at the center the next day.

Wilbur wasn’t feeling well, so he appreciated the call. This follow-up likely prevented his wife from contracting HIV, he said.

His test results indicated he had a high VL, putting him at risk of opportunistic infection and HIV transmission. After his wife and children were found to be HIV negative, Wilbur began monthly intensive adherence counseling sessions with a psychosocial counselor.

After completing three consecutive sessions as per Ugandan Ministry of Health guidelines, Wilbur received the good news that he had achieved a suppressed VL.

Following up with Patients to Ensure Regular Testing

Wilbur is just one of the many success stories from an ongoing effort at 134 health care facilities – including Buyinja HC IV – to ensure timely and regular VL testing for all people living with HIV receiving care at the facilities. This effort is being supported by the USAID Regional Health Integration to Enhance Services in East Central Uganda (USAID RHITES-EC) Activity, implemented by URC.

To identify all patients due a VL test, health care workers at HIV treatment clinics carry out file audits, labeling the file of each patient due a test with a sticker indicating the client’s test status. Red indicates non-suppressed, green represents suppressed, and yellow shows that a client is due for a VL test.

Clients with yellow stickers are contacted by phone to remind them to come for their VL tests. For those unable to visit the clinic due to transport costs, health workers visit them in their communities and lab personnel collect blood samples.

Wilbur’s blood sample was taken at the antiretroviral therapy (ART) clinic within Buyinja Health Center instead of at a lab, an intervention that has enabled the health care facility to closely monitor VL testing, avoid losing patients, and reduce lab wait times.

Clients receive health education and counseling on VL so they become more involved in self-care and learn how to obtain care even when far away from their regular health care facility. Wilbur received this health education and knows exactly when to go for his next VL test.

“My next viral load is due in February 2021, and I plan to have it done on my appointment day,” Wilbur said. “In addition, I now take my medication every day and on time.” Support from his wife also has helped keep Wilbur on track, he said.

Clinic Tracking of Viral Loads Improves

Results of all these efforts have been impressive. VL coverage at Buyinja HC IV improved from 77% in April 2019 to 95% in September 2020.

The same interventions at 134 health care facilities in East Central Uganda led to VL coverage improving from 80% in April-June 2019 to 92% in July-September 2020.

Interventions that Improve Viral Load Coverage

  • Conduct file audits to identify patients due for HIV VL testing
  • Make pre-visit phone calls to patients to remind them about their VL testing appointment
  • Streamline VL clinic processes at ART points of care, including adult, adolescent, pediatric, and mother-baby care points to ease identification of patients due for VL testing, follow-up, and to promote awareness of new VL testing dates
  • Integrate VL testing into the community for patients who miss clinic appointments
  • Implement home delivery of ART
  • Conduct VL mop-up campaigns (known as VL camps) at facility and household levels for patients due for VL testing
  • Leverage VL camps for children and adolescents to hold meetings with parents and guardians (caregiver meetings) to emphasize the importance of scheduled VL testing and ART adherence