Know your numbers: a catalyst to improve viral load coverage in Western Region of Ghana

BACKGROUND: A critical pillar in achieving HIV epidemic control is ensuring patient-centered services to all clients on ART Yet, as of 2019, viral load (VL) coverage for persons on ART was only 48%, with 68% of those clients achieving viral suppression, according to the Global AIDS Monitoring 2019 report. Challenges faced nationally include frequent breakdown of VL testing machines, reagent shortages, low demand generation, poor access to VL tests, VL sample transportation and delays in receiving test results.
DESCRIPTION: The USAID Strengthening the Care Continuum Project (Care Continuum), led by JSI Research & Training Institute, Inc., implemented enhanced VL demand generation activities in the Western Region to increase VL testing. These include the 'Know Your Numbers' campaign where VL literacy messages were developed promoting Undetectable=Untransmittable (U=U) messaging. The Project trained case managers (CMs) to support newly-diagnosed clients with HIV to navigate and start ART treatment. CMs provide motivational counselling on adherence to PLHIVs, track clients due for VL testing using Google calendar reminder alerts prompted by the client monitoring mechanism in GHS DHIS2 eTracker at all sites providing ART services. Additionally, a VL Monitoring System (VLMS) was piloted to interface with the Laboratory Information Management System (LIMS) to enable electronic transmission of VL results to facilities. Advocacy meetings with key stakeholders were also held to discuss practical solutions to addressing the VL testing gaps.
LESSONS LEARNED: VL coverage, which includes clients receiving timely results, increased from 59% (6331 /10,663) in December 2019 to 92% (13,995 / 15282) by September 2021. Western Region has reduced VL result turnaround time by integrating the LMIS and VLMS so that VL requests and VL test results are electronically transmitted to health facilities through the public sector eTracker system. Stakeholders suggested synchronizing dates of VL samples collection and ART refill appointments dates. This approach enhanced VL sample collection.
CONCLUSIONS: VL literacy and demand creation efforts should be replicated in other regions of Ghana to improve VL coverage. Greater involvement of PLHIV as champions advocating U=U campaign in their communities will catalyze improving the third 95. Ensuring reliable logistics for VL testing is also critical.

Download the e-Poster (PDF)