Background: By December 2016, Latin America and Caribbean (LAC) countries reached 56% antiretroviral treatment (ART) coverage among estimated people living with HIV in the region. Since 2013, WHO recommends viral load (VL) testing as preferred monitoring tool during ART, but gaps in VL access and coverage persist.
Description: We analyzed data officially reported in 2017 by 31 LAC country to UNAIDS /WHO/UNICEF through the Global AIDS Monitoring reporting system and AIDS Medicine and Diagnostic Service (AMDS) survey (situation at December 2016) to assess existing gaps in VL policies, capacity and coverage.
Lessons learned: All reporting countries have routine VL monitoring policies; 10% (3/31) reported partial implementation (Belize, Bolivia and Haiti). Most countries (80%; 25/31) have VL lab capacity; only Organization of Eastern Caribbean States (OECS) countries outsource VL testing to an external lab (Barbados). Most countries (61%; 19/31) recommend biannual VL monitoring, 32% (10/31) annual and 2 countries more frequent monitoring (Costa Rica, Bahamas). Comparing annual estimated VL volumes (based on people on ART and VL testing frequency in national policies; Data reported by 22 countries) 59% (13/22) countries performed ≤75% of the estimated volume (regional median 59%), while four (El Salvador, Grenada, Mexico, Peru) exceeded their estimated amount. VL coverage (proportion on ART with at least one VL test/year; data reported by 24/31 countries) showed a regional median of 82.4% (Range: 17.7-100); 42% countries (10/24) reporting VL coverage ≤75%; 3 countries with < 50% (Cuba, Ecuador, Haiti). VL coverage was 83.8% in Latin America (10 countries) and 74.5% in the Caribbean (14); 84.7% in men; 87.6% in women; 80% in children < 15; 84.6% in persons ≥15.
Conclusions/Next steps: Despite the adoption of routine VL monitoring policies and availability of lab services, VL coverage in people on ART falls short in many LAC countries. Programmatic causes should be further investigated and addressed to ensure optimal laboratory monitoring during treatment. In addition some inefficiencies were detected (too frequent VL monitoring; number of tests exceeding estimated volume) which should also be corrected.