'I achieved, have you?' A surge campaign to close viral load testing gaps among key populations in Zambia

BACKGROUND: USAID Open Doors (ODP) is an HIV prevention project implemented in Zambia targeting sex workers (SWs), men who have sex with men (MSM), and transgender people. The project is implemented by FHI 360 and funded by USAID and PEPFAR. The project, focused in eight high-traffic districts, refers individuals diagnosed HIV positive to public clinics for antiretroviral therapy (ART) initiation and management. Due to access challenges, only 37% of key population (KP) members eligible for viral load (VL) testing had received the test by the end of July 2020, well below the 75% project target. ODP implemented a VL testing campaign to review program processes and close coverage gaps by September 2020.
DESCRIPTION: A surge campaign, entitled 'I achieved, have you?', was implemented August 17 to September 30, 2020, to address the identified gaps. The surge included virtual technical assistance (TA) from FHI 360, and online meetings with all sites to conduct root cause analyses and targeted quality improvement interventions. In each site, clients overdue for VL testing from October 2019'September 2020 were line listed. Clients with accurate phone numbers and addresses were tracked through phone calls and home visits. Site teams made appointments to collect samples at convenient locations. Site staff were given transport vouchers to ensure all samples collected were promptly delivered for processing.
LESSONS LEARNED: Out of 3,985 clients due for VL testing in 2020, 960 (24%) were eligible during the surge period. Of these, 713 (74%) [(511 SWs, 181 MSM, and 21 transgender individuals)] were tracked, and 592 (62%) gave blood samples. Project VL coverage increased from 37% to 53%. Inaccurate contact details (19.5%), lost to follow-up (16.8%), and increased KP displacement during COVID-19 (5.8%) were the main reasons for those not tested. At the facility level, a limited number of PCR machines and long turnaround time for results of up to 6 weeks (IQR=2'6 weeks) impeded achievement of program targets. As of December 2020, VL coverage stood at 69.2%.
CONCLUSIONS: The surge helped the program identify bottlenecks and improve VL testing. However, access to VL testing will remain suboptimal until testing capacity and efficiency are also addressed.