Background: Côte d''Ivoire use of HIV Viral load (VL) for the monitoring of patients receiving antiretroviral therapy (ART) began in 1998 as a pilot program under the UNAIDS/Ministry of Health Drug Access Initiative (DAI). From 2002 to 2014, VL testing was available to less than 10% of patients for immunologic and/or clinical failure monitoring, and was accessible only in Abidjan the capital. Following WHO 2015 guidelines and the need to increase access to VL testing, CDC used the lab in the box approach to scale-up and decentralize access to VL testing.
Methods: We analyzed 2015-2017 VL test results from aggregate patient data obtained from the laboratory information system of 15 VL laboratories. Testing coverage and viral load suppression rate by age group, gender and region were assessed. VL was measured using plasma on the Roche Ampliprep Cobas Taqman 48&96; patients had access to VL testing every 6 months during the first year and yearly thereafter.
Results: A total of 221,990 patients received ART nationally between October 2015 and August 2017, with a 12-month retention rate of 85%. Access to at least one VL test per year increased from 14% to 61% for a total of 134,877 patients during the study period, including 41.5% from districts outside of Abidjan. The number of laboratories increased from 6 to 15 in the same period. Among patients with access, 74% were female and 5.6% children (0-14 years). Seventy seven percent of tested patients achieved VL < 1000 copies/mL [95% CI: 55-82]; the VL suppression rate was similar for female and male, 78% and 77% respectively. While children and adolescents (15-19 years) had the lowest rate at 56% and 55% respectively, young adults'' (20-24 years) rate was 67%, and patients ≥25 years, 79%.
Conclusions: The experience of Côte d''Ivoire provides evidence that routine VL can be achieved using appropriate scale-up strategies such as lab in the box, minimized reagent stock out, and a strong sample transportation system. The low rate of VL suppression in children and adolescents is a challenge that needs to be addressed in order to minimize appearance of HIV drug resistance strains.

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