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, 9 (4), 206-214

Journey Towards Universal Viral Load Monitoring in Maputo, Mozambique: Many Gaps, but Encouraging Signs


Journey Towards Universal Viral Load Monitoring in Maputo, Mozambique: Many Gaps, but Encouraging Signs

Sarah Swannet et al. Int Health.


Introduction: Viral load (VL) monitoring for people on antiretroviral therapy (ART) is extremely challenging in resource-limited settings. We assessed the VL testing scale-up in six Médecins Sans Frontières supported health centres in Maputo, Mozambique, during 2014-15.

Methods: In a retrospective cohort study, routine programme data were used to describe VL testing uptake and results, and multi-variate logistical regression to estimate predictors of VL testing uptake and suppression.

Results: Uptake of a first VL test was 40% (17 236/43 579). Uptake of a follow-up VL test for patients with a high first VL result was 35% (1095/3100). Factors associated with a higher uptake included: age below 15 years, longer time on ART and attending tailored service delivery platforms. Virological suppression was higher in pregnant/breastfeeding women and in community ART Group members. Patients with a high first VL result (18%; 3100/17 236) were mostly younger, had been on ART longer or had tuberculosis. Out of 1095 attending for a follow-up VL test, 678 (62%) had virological failure. Of those, less than one-third had started second line ART.

Conclusion: This was the first study describing the uptake and results of VL testing scale-up in Mozambique. Identified gaps show patient and programmatic challenges. Where service delivery was customized to patient needs, VL monitoring was more successful.

Keywords: Antiretroviral therapy; HIV; Mozambique; Operational research; Sub-Saharan Africa; Viral load monitoring.


Figure 1.
Figure 1.
Viral load cascade of eligible patients in MSF-supported health centers in Maputo, Mozambique, between 2014 and 2015. ART: antiretroviral therapy; VL: viral load. a Eligible for first VL testing included all patients more than 6 months on first line ART.

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    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014. Available from: [accessed 6 October 2015].
    1. World Health Organization (WHO) Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. Second edition. Geneva: WHO; 2016. Available from: [accessed 25 September 2016].
    1. Roberts T, Cohn J, Bonner K et al. Scale-up of routine viral load testing in resource-poor settings: current and future implementation challenges. Clin Infect Dis 2016;62:1043–48. - PMC - PubMed
    1. UNITAID. Implementation of CD4 and viral load testing in decentralized, remote and resource-limited settings (2012–2016). Available from: [accessed 6 July 2017].
    1. Johnston V, Fielding K, Charalambous S et al. outcomes following virological failure and predictors of switching to second-line antiretroviral therapy in a South African treatment programme. J Acquir Immune Defic Syndr 2012;61:370–80. - PMC - PubMed