Improving access to HIV viral load testing in the northern regions of Cameroon

BACKGROUND: Although viral load (VL) services are free in Cameroon since January 2020, access has been limited in the three Northern regions. Only one conventional platform served the regions with four point of care (POC) machines for specimen analysis. Frequent and prolonged reagent stock-outs, limited cold-chain capacity, long distances to health facilities (HFs) and poor roads amplified VL access challenges. We describe the impact of interventions to improve VL access across the Northern regions.
DESCRIPTION: From October 2019, case managers were assigned client cohorts to determine VL eligibility; VL focal persons were appointed in each supported HF for monitoring and results documentation; VL registers were printed and staff trained; the sample transport system was reorganized with establishment of hub-and-spoke laboratories, cold chain was strengthened with use of mobile coolers, solar panel installation and refrigerators. A new conventional platform was installed and continuous lab staff mentorship was initiated. Backup laboratories were identified to handle VL testing during reagent stock-outs. Retrospective routine data collected quarterly (Q) [Q1:October-December 2019;Q2:January-March 2020;Q3:April-June 2020;Q4:July-September 2020] from 74 ICAP-supported HF were analyzed to determine trends by quarter across the VL cascade.
LESSONS LEARNED: The VL coverage increased progressively from Q1(5.9%) to Q4(39.1%) with higher coverage for children (43%) compared than adults (39%) by Q4. The number of VL samples collected increased by 399% between Q1(1,756) and Q2(8,763), but declined by 26% between Q3 (7,382) and Q4(5,412). Return of results also improved from 52% (3,044/5,854) by the end of September 2019 to 74% (17,260/23,313) by September 2020. The average VL suppression was lower for children (57%) compared with adults (77%) and was similar across the four quarters.
CONCLUSIONS: Despite challenges, there was a significant increase in VL access over the four quarters in the northern regions with Covid-19 slowing down access from Q3. The strategies implemented were successful but need to be streamlined to address Covid-19 related challenges and further scaled up through strengthening identification of eligible patients using the electronic register and increasing the number of POCs across the three regions. Suppression of VL especially for children will be a priority subsequently.